Child Dedication Form

Contact Parents Information *

First Name

Last Name

Childs Name *

First Name

Last Name

Checkbox *

Boy

Girl

Birthdate *

MM

DD

YYYY

Mother's Name *

First Name

Last Name

Is the mother a follower of Jesus? *

Yes

No

Does the mother regularly attend New Life? *

Yes

No

Father's Name

First Name

Last Name

Is the father a follower of Jesus?

Yes

No

Does the father regularly attend New Life?

Yes

No

Parents' Marital Status *

Singel

Engaged

Married

Separated

Devoiced

I agree to the following: *

I understand that by dedicating our child, we are making a commitment that we have a sincere desire to raise our child in a godly, Christ-centered home.