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
Date
Mother's Name*

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

MonthDayYear
Date
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?*

Yes, this is my home church, and I attend here.No, I do not consider CCCV my home church.
How long have you attended CCCV?*
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?*

MotherFather
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?*

YesNo
Father's Date of Salvation
Has the mother accepted Jesus Christ as her personal Lord and Savior?*

YesNo
Mother's Date of Salvation
Have the parents previously attended a dedication class at Calvary Chapel Chino Valley?*

YesNo
When?
Month and Year
What does having your child(ren) "dedicated" mean to you?*
Is more than one child being dedicated?*

YesNo
What is the full name of the child? *
Please list the birthdate of the child.*

MonthDayYear
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. *

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Child Dedication Application