Child Dedication Form

Child Dedication Application
Are you requesting a child dedication as a single parent?
Father's Name

First NameLast Name
Father's Cell Phone
Father's Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mother's Name

First NameLast Name
Mother's Cell Phone
Mother's Birthdate

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
Primary contact
Marital Status of Parents
For how long have the parents been in the martial status chosen above?
Do you (the parent requesting a dedication) attend Calvary Chapel Chino Valley with Pastor David Rosales?
How long have you attended CCCV?
Do both parents attend Calvary Chapel Chino Valley with Pastor David Rosales?
How often do both parents attend Calvary Chapel Chino Valley in-person?

Other
Please indicate which parent attends Calvary Chapel Chino Valley and considers Pastor David Rosales their pastor?
We are very sorry, but the Child Dedication class is only available to parents who consistently attend Calvary Chapel Chino Valley as their home church. If you have further questions, please call our church office at (909) 464-8255.
How long have both parents attended our fellowship together?
Has the father accepted Jesus Christ as his personal Lord and Savior?
Father's Date of Salvation
Has the mother accepted Jesus Christ as her personal Lord and Savior?
Mother's Date of Salvation
Have the parents previously attended a dedication class at Calvary Chapel Chino Valley?
When?
Month and Year
What does having your child(ren) "dedicated" mean to you?
Is more than one child being dedicated?
What is the full name of the child?
Please list the birthdate of the child.

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
If multiple children are being dedicated, list the names and the birthdates below. (Use the "Add Row" button to add and list all children.)
By signing below, I certify that all information entered within this application is true.
Should be Empty:

Child Dedication Application