Baby Dedication Application

“WHERE THE SPIRIT OF THE LORD IS, THERE IS LIBERTY.” 2 CORINTHIANS 3:17

PARENT AND GUARDIAN INFORMATION

Today's Date

Name

This address will receive a confirmation email

Phone

Address

CHILD INFORMATION

Child's Full Name

Date of Birth

Gender

Male Female

CHURCH CONNECTION & INFORMATION

How long have the parent(s) attended Liberty Pentecostal Church Bowmanville?

Will both parents be present at the dedication?

Why do you want your child dedicated?

Notes or family information the Pastor should be aware of:

*All applicants must meet with Pastor Thom prior to dedication. Please call 905-623-5100 to make

an appointment.

CONSENT & AGREEMENT

I hearby confirm that the information supplied is both true and accurate.

Father's First and Last Name

Mother's First and Last Name

Date Signed

OFFICE USE ONLY

Approved by

Date of approval

Officiating Pastor

Date of Dedication

Description

Please fill out this form and click submit.