Child Dedication Information Request Form

If you have never had your child dedicated, and would like to do so, please complete the following form:

Parents' Name(s):
Child(rens) Name(s):
Birth Date(s):
Email Address:
Phone Number:
The next Child Dedication class will be held on: May 2, 2010, 9-10:15 am in the Upper Room in Heartland. Will you be able to attend on this date?  

If not, please contact us for an alternate date/time for the class, and note that in the Questions section of this form.



Will you need childcare during the class?



Questions? Please list any questions you may have: