Child Dedication Application

Child Dedication Application

115-03 Sutphin Boulevard, Jamaica, NY 11434 | FriendlyChurchNY@gmail.com | SUBMIT THIS FORM FOR EACH CHILD THAT IS TO BE DEDICATED.
Applicant's Name

First NameLast Name
Requested Date of Child Dedication

MonthDayYear
Date
Child's Name

First NameLast Name
Child's Gender

MaleFemale
Child's Date of Birth

MonthDayYear
Date
Hospital Name
Hospital Address, City, State, and Zip Code

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
First and Last Name of the Child's Mother

First NameLast Name
First and Last Name of the Child's Father

First NameLast Name
Applicant's Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Applicant's Phone Number
Please enter a valid phone number.
Applicant's Email
example@example.com
Statement of Intent

With God’s help, I commit to lovingly support and guide this child in the ways of the Lord. I purpose to provide godly teaching, a Christ-centered example, and continual encouragement. I willingly accept the responsibility to pray for this child, to nurture their faith, and to encourage them to worship God, trust in Him, and grow in their relationship with Jesus Christ.

I further commit to supporting this child as they take their place within the life of the Church, helping them to walk in God’s truth, love, and purpose all the days of their life.
Godparents (include first and last name, maximum of 4)
Grandparents (include first and last name, maximum of 4)
Should be Empty: