Choose a Sunday to dedicate your child. *

Date of choice is not guaranteed.

MM

DD

YYYY

Child's name *

First Name

Last Name

Child's date of birth *

MM

DD

YYYY

Parent/Guardian 1 *

First Name

Last Name

Parent/Guardian 2

First Name

Last Name

Married? *

Yes

No

Anniversary *

MM

DD

YYYY

I/we have become members of Church For The City by attending Open House. *

Yes

Not yet

Mobile Phone Number *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Salvation Date: Parent/Guardian 1 *

When did you give your life to Jesus?

MM

DD

YYYY

Salvation Date: Parent/Guardian 2

When did you give your life to Jesus?

MM

DD

YYYY

Date of Water Baptism: Parent/Guardian 1 *

When were you baptized? *Both parents/guardians must be water baptized before child dedication.

MM

DD

YYYY

Date of Water Baptism: Parent/Guardian 2

When were you baptized? *Both parents/guardians must be water baptized before child dedication.

MM

DD

YYYY

Have you watched Pastor Tyrone's Child Dedication info video? *

Yes

Not yet