Parent Child Dedication Request

Parent First Name

Parent Last Name

Email

Phone Number

Child First Name

Child Last Name

Birthdate

Gender

Add A Child?

Yes

No

Child's First Name

Child's Last Name

Birthdate

Gender

Mothers First Name

Mothers Last Name

Fathers First Name

Fathers Last Name

Siblings Names (if applicable)

What is your preferred service date and time?

Sept 22, 2024 - 9:00am

Sept 22, 2024 - 10:15am

Jan 26, 2025 - 9:00am

Jan 26, 2025 - 10:15am

April 27, 2025 - 9:00am

April 27, 2025 - 10:15am

Are you a Member of First Baptist Cleveland?

Yes

No

I understand there will be individual family meetings with the Preschool Minister 2 weeks prior to the date selected.

I understand.