BABY & CHILD DEDICATION
SET APART FOR THE LORD'S USE...
Date Of Filling In Form *
MM
/
DD
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Child's Full Names & Surname *
Child's Nickname (If Applicable)
Gender of Child *
Required
Birth Date of Child *
MM
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DD
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Child's Age *
Parent 1: Name & Surname *
Parent 1: Contact Number *
Parent 1: Email *
Parent 2: Name & Surname (If Applicable)
Parent 2: Contact Number (If Applicable)
Parent 2: Email
Are You CCM Members? *
Yes
No
Interested
Please Select:
Please Select The Desired Dedication Date (Our Admin will confirm availability) *
MM
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Next Step
Our friendly Admin will get in touch upon submission of this form!

They will request a high resolution photograph of your child.
You can also mail it directly to admin@cornerstonem.co.za with the Subject: 'Child Name' Dedication Pic...
For Admin Use Only
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