Riverbend Child Dedication

Child Dedication
Please fill out the following form and we will get in contact with you!

When we receive this form, we will email you with some more information!
Parent 1*

First NameLast Name
Email
example@example.com
Parent 2

First NameLast Name
Phone Number*

Area CodePhone Number
Child to be Dedicated*

First NameLast Name
Child Name

First NameLast Name
Child Name

First NameLast Name
Child Name

First NameLast Name
Child 1 Birth Date*

MonthDayYear
Add more?*

YesNo
Child 2 Birth Date

MonthDayYear
Child 3 Birth Date

MonthDayYear
Child 4 Birth Date

MonthDayYear
Which gathering do you want your child to be dedicated at?*

9:00 am11:00 am
Do you have any other kids? (List names and ages)
Is there a scripture, song or verse you'd like read?
Do you have any family members you'd like on stage with you? If so, please name them and your relationship.
How long have you attended Riverbend?*
E-mail*
Should be Empty: