Child Dedication Application
Are you requesting a child dedication as a single parent?
*
No, both father and mother are together.
Yes, I am a single father.
Yes, I am a single mother.
Father's Name
*
First Name
Last Name
Father's Cell Phone
*
Father's Birthdate
*
-
Month
-
Day
Year
Date
Mother's Name
*
First Name
Last Name
Mother's Cell Phone
*
Mother's Birthdate
*
-
Month
-
Day
Year
Date
Email
*
Primary contact
Marital Status of Parents
*
Please Select
Married
Engaged
Dating
Separated
Divorced
Widowed
For how long have the parents been in the martial status chosen above?
*
Do both parents attend Calvary Chapel Chino Valley with Pastor David Rosales?
*
Yes, this is the home church of both parents.
No, only one parent attends Calvary Chapel Chino Valley.
Neither parent attends Calvary Chapel Chino Valley.
How often do both parents attend Calvary Chapel Chino Valley in-person?
*
Parents attend one of Sunday morning services.
Parents attend the Wednesday evening services.
Other
Please indicate which parent attends Calvary Chapel Chino Valley and considers Pastor David Rosales their pastor?
*
Mother
Father
It was noted that neither parent considers Calvary Chapel Chino Valley as their home church. Do the parents currently have a home church at the moment?
*
Yes
No
Please explain why you want to dedicate your child at Calvary Chapel Chino Valley.
Please explain why this is.
How long has that parent attended our fellowship?
*
How long have both parents attended our fellowship together?
*
Has the father accepted Jesus Christ as his personal Lord and Savior?
*
Yes
No
Father's Date of Salvation
Has the mother accepted Jesus Christ as her personal Lord and Savior?
*
Yes
No
Mother's Date of Salvation
Have the parents previously attended a dedication class?
*
Yes
No
When?
Month and Year
What does having your child(ren) "dedicated" mean to you?
*
Is more than one child being dedicated?
*
Yes
No
What is the full name of the child?
*
Please list the birthdate of the child.
*
-
Month
-
Day
Year
Date
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.
*
Clear
Submit Form
Should be Empty: