Child Dedication Application

Child Dedication Application
Date of Application*

MonthDayYear
Date
Hour MinutesAM/PM Option
Requested Date of Dedication (Saturdays ONLY)*

MonthDayYear
Date
What is the number of all attendees (Including Parents & siblings)?*
MAXIMUM OF 20 ATTENDEES
Contact Person
Contact Name*

First NameLast Name
Contact Phone*
Please enter a valid phone number.
Contact Email*
example@example.com

Child's Info
Child's Info
Name of Child*

First NameMiddle NameLast NameSuffix
Date of Birth*

MonthDayYear
Place of Birth (City, State, Country)*
Enter Initials That Child's Information Is Correct*

Father's Info
Father's Info
Father's Name *

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Number*
Mobile Number
Work Number
E-mail
example@example.com

Mother's Info
Mother's Info
Mother's Name*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Primary Number*
Mobile Number
Work Number
E-mail*
example@example.com
A Meeting With An Elder Is Required PRIOR To The Dedication:

I consent & acknowledge a meeting with an Elder is required prior to dedicationI do not consent to a meeting with an Elder
Parent's Signature*