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Child Dedication Application

Dedications are for infants and children 5 years of age or younger.

Your name *

Last name

Email address *

Name *

Phone Number *

XXX-XXX-XXXX

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Street Address *

Apt/unit/box (optional)

City, State, Postal Code *

Child's Name *

Child's Gender *

Male

Female

Child's Birth Date *

Father's Full Name *

Father's Home Address *

For Father: Please describe your faith journey and relationship with Jesus. *

Mother's Full Name *

Mother's Home Address *

For Mother: Please describe your faith journey and relationship with Jesus. *

Marital Status of Child's Parents *

Married

Engaged

Single

Other

Have both parents accepted Jesus Christ as Lord and Savior? *

Do both parents REGULARLY attend Bethel Church? *

Yes

If Yes, How long have you REGULARLY attended Bethel Church? *

If you do not attend Bethel Church, which (if any) church do you attend? *

What is your current involvement at Bethel Church? *

Sunday Attender

Church Partner

Small Group

Serve Team

Other

Which service would you prefer to participate in?

9am

11am

Questions or Comments

By completing this form, I give permission for photographs and video recordings of my child/children and family to be taken with Bethel Church.

Bethel Church
bethel@bethelnj.church
856-228-5050

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