Baby Dedication Registration

Marital Status - You must select one of the following
Are you a legally married couple? *

Yes No
Are you a single parent raising your child alone? *

Yes No
Are you an unmarried couple but living together? *

Yes No
PLEASE NOTE: If you are not married but still living together, Pastor Ray cannot dedicate your baby until you either get married or are no longer living with your partner. When this issue has been settled, a baby dedication date will be scheduled. if any questions about this policy, please see a Church Elder.
Date of Application

Month Day Year
Mother's Full Name

First Name Last Name
Father's Full Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail Address (If Any)
Home Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Child's Full Name

First Name Last Name
Date of Birth

Month Day Year
Names of brothers and sisters (include birth dates)
Fill out a separate form for each child being dedicated

Please answer all relevant questions
Fathers/Mothers
Are you a member of LWCC?

Yes No
If only one parent is a member, which one?

Father Mother
Do you attend LWCC on a regular weekly basis?

Yes No
Which parent(s) is a confessed born-again believer?

Father Mother Both Neither
If only one parent attends regularly, which will be taking full responsibility to raise this child in a Christian home?

Father Mother
Guardians
What is your relationship to the child?
What is guardian's full name?
Is the guardian a member of LWCC?

Yes No
Do you attend LWCC on a regular basis?

Yes No
Home Phone

Area Code Phone Number
Work Phone

Area Code Phone Number
Other Questions
Will someone be taking pictures?

Yes No
Will there be God parent(s)

Yes No
Will there be other family and friends?

Yes No
Enter the message as it's shown *
Should be Empty:

Marital Status - You must select one of the following

Fill out a separate form for each child being dedicated

Fathers/Mothers

Guardians

Other Questions