Baby Dedication Request Form

Thank you for your interest in dedicating your child to the Lord. Please complete this formand submit it to the church office. A member of our pastoral team will contact you with further details.

Instructions:

• This form must be submitted at least 3 weeks prior to your engagement.

• Submission of this form does not imply an approval of your requested date.

• Baby dedications are scheduled to occur at 10:00 am on 4th Sundays during worship experience.

Today’s Date:

Parent(s)/Guardian(s) Information:

Full Name(s):

Address

City

State

ZIP

Phone Number: *

Email Address: *

Child’s Information:

Full Name:

Date of birth:

Gender:

Male

Female

Spiritual Commitment:

Are you a member of this church?

Yes

No

If not, are you interested in learning more about membership?

Yes

No

Briefly describe your faith journey and why you would like to dedicate your child:

Family & Guests:

Will family members or guests be attending?2

Yes

No

Estimated number of attendees:

Photography & Media Release:

Do you give permission for photos/videos of the dedication to be used for church media purposes?

Yes

No

Additional Requests or Special Considerations:

By signing below, I/we acknowledge the significance of this dedication and commit to

raising our child in a Christ-centered home.

Signature(s):

Clear

Date

For Office Use Only:

Date Received:

Approved Dedication Date:

Pastor’s Approval:

Yes

No

Notes: