Child Dedication
If you would like your child to participate in Child Dedication, please complete this form.
Date *
Your answer
Father's Full Name (enter only if participating on stage)
Your answer
Mother's Full Name (enter only if participating on stage)
Your answer
Street Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Phone *
Your answer
Alternate Phone
Your answer
Email *
Your answer
Which service would you like to participate in? *
I authorize my child's/children's picture to be used in any/all areas of Children's Ministry at Port City Church *
Child's Full Name (First, Middle, Last) *
Your answer
Child's Birthday (MM/DD/YYYY) *
Your answer
My child is a *
I have another Child I would like dedicated? *
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