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Child Dedication Form (Updated)

Your name *

Last name

Email address *

Child's Information

Child's Name: *

Gender *

Child's Name:

Gender

Parent's General Info

Mother's Name *

Father's Name *

Address *

Country

Country

Street Address

Apt/unit/box (optional)

City

State

Postal code

Mother's Phone Number *

Mother's Email *

Father's Phone Number *

Father's Email *

Mother

Have you committed your life to following Christ?

Do you attend LaFayette Church of God regularly?

At least 2 or more times monthly

Marital Status

If married, is your spouse the child's father?

If single, are you living with someone who is not your spouse?

Are you and the child's father in agreement with dedication?

Father

Have you committed your life to following Christ?

Do you attend LaFayette Church of God regularly?

At least 2 or more times monthly

Marital Status

If married, is your spouse the child's father?

If single, are you living with someone who is not your spouse?

Are you and the child's mother in agreement with dedication?

Grandparents

Name of Mother's Parents

Will they attend the dedication?

Yes

No

Would you like them to be recognized?

Yes

No

Name of Father's Parents

Will they attend the dedication?

Yes

No

Would you like them to be recognized?

Yes

No

Siblings

Name

Relation

Name

Relation

Name

Relation

Will they attend the dedication?

Yes

No

Would you like them to be recognized?

Yes

No

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LaFayette Church of God
info@lafayettecog.org
706.450.0872

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