Information for Child Dedication

Name of parent filling out this form. *

Today's date * +

Which campus do you currently attend? *

At which campus would you like to dedicate your child? *

Child's Information

Child's first name *

Child's middle name

Child's last name *

Gender *

Child's date of birth * +

Father's Information

Father's name *

Father's email *

Best phone # to reach dad *

Is dad currently attending Church of the Redeemer? *

How long has he attended our church? *

Dad, briefly describe your Christian experience. How did you become a Christian and what does this mean to you? *

Mother's Information

Mother's name *

Mother's email *

Best phone # to reach mom *

Is mom currently attending Church of the Redeemer? *

How long has she attended our church? *

Mom, briefly describe your Christian experience. How did you become a Christian and what does this mean to you? *

Additional Information

Please indicate your current address below and let us know the following: *

Dad and mom both live at this address.

This is mom's address.

This is dad's address.

Street Address *

City *

State *

Zip Code *

Have you completed our Living Stones (or Starting Point) class? *

How long have you been married? (If you are a single parent, please indicate that.) *

Have you listened to the audio file from Pastor Dale on the dedication of children? *

Which service would you prefer for the dedication? *

11:00 am - Sunday (Frederick)	11:00 am - Sunday (Gaithersburg)
1:00 pm - Sunday (Gaithersburg)

Briefly describe what child dedication means to you. *

I verify that the information I have provided in this form is accurate to the best of my knowledge. *

Please note the following: We may need to reschedule your child's dedication if you arrive later than 15 minutes before the service starts, since that time is needed to prepare each family. All parties must have modest clothing and we reserve the right to reschedule the dedication if the attire is not appropriate.