Child Dedication Form
 
Child Dedication Form
Please complete the following information, which will be used to enable us to process your Child Dedication
Last Name (Child)  * 
First Name (Child)  * 
Child’s Date of Birth  * 
Gender  * 
Father’s Last Name (If applicable)
Father’s First Name (If applicable)
Mother’s Last Name (If applicable)
Mother’s First Name (If applicable)
Relationship to the child?  * 
Street Address  * 
City  * 
State  * 
Zip  * 
Cell Phone
Do you attend Bethel Family Worship Center?  * 
Who will be bringing the child forward during the dedication ceremony? (Please note: Only the parents/guardians will participate in the ceremony.)
Why do you desire child dedication? * 
Have you and your spouse (if applicable) accepted Jesus Christ into your lives as your Savior? * 
Your Email Address  * 
 
 
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