Baby/Child DEDICATION interest form

Note: The deadline for signing up your child to be dedicated is 5:00p, the Wednesday before the dedication service.

Mother's Name

First Name

Last Name

Father's Name

First Name

Last Name

Email

Phone

(###)

###

####

Child's Name

First Name

Last Name

Child's Gender

Male

Female

Child's Date of Birth

MM

DD

YYYY

Child's City/State of Birth

Dedication Certificate Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you a regular attender of The Lighthouse Church?

Yes

No

baby/Child dedication