Baby Dedication Registration

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

YesNo
Are you a single parent raising your child alone?*

YesNo
Are you an unmarried couple but living together?*

YesNo
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

MonthDayYear
Mother's Full Name

First NameLast Name
Father's Full Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

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

Area CodePhone Number
Work Phone

Area CodePhone Number
Child's Full Name

First NameLast Name
Date of Birth

MonthDayYear
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?

YesNo
If only one parent is a member, which one?

FatherMother
Do you attend LWCC on a regular weekly basis?

YesNo
Which parent(s) is a confessed born-again believer?

FatherMotherBothNeither
If only one parent attends regularly, which will be taking full responsibility to raise this child in a Christian home?

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

YesNo
Do you attend LWCC on a regular basis?

YesNo
Home Phone

Area CodePhone Number
Work Phone

Area CodePhone Number
Other Questions
Enter the message as it's shown*
Should be Empty:

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Marital Status - You must select one of the following

Fill out a separate form for each child being dedicated

Fathers/Mothers

Guardians

Other Questions