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Child Dedication Application
22
Questions
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1
Child's First Name:
*
This field is required.
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2
Child's Middle Name
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3
Child's Last Name
*
This field is required.
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4
Gender of Child
*
This field is required.
Please Select
Boy
Girl
Please Select
Please Select
Boy
Girl
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5
Child's Birthday:
*
This field is required.
-
Month
Day
Year
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6
Mother's Name
*
This field is required.
First Name
Last Name
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7
Mother's Phone Number
*
This field is required.
Area Code
Phone Number
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8
Mother's E-mail
*
This field is required.
example@example.com
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9
Does the mother attend Stone Creek Church?
*
This field is required.
YES
NO
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10
Has the mother completed SCC Next?
*
This field is required.
YES
NO
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11
How did the Mother come to know Jesus Christ?
*
This field is required.
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12
Father's Name
*
This field is required.
First Name
Last Name
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13
Father's Phone Number
*
This field is required.
Area Code
Phone Number
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14
Father's E-mail
*
This field is required.
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15
Does the Father attend Stone Creek Church?
*
This field is required.
YES
NO
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16
Has the father completed SCC Next?
*
This field is required.
YES
NO
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17
How did the Father come to know Jesus Christ?
*
This field is required.
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18
What are the names and ages of the child's siblings?
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19
How many seats would you like reserved for your family and friends?
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20
Picture of Child
*
This field is required.
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Max. file size
: 10.0MB
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21
2nd Picture Optional:
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: 10.0MB
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22
Stone Creek Church Child Dedications are scheduled and confirmed upon Pastoral approval. Please sign below indicating that you have read and understand this.
Clear
Signature
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