Child Dedication Form

Child's Name

Child's Birthdate

Child's Gender

Male Female

Child's Fathers First Name

Last name

Child's Mothers First Name

Last Name

This address will receive a confirmation email

Phone

Address

Do the mother and father of the child to be dedicated attend Southside Assembly of God Church?

Will both parents be present for the child dedication?

Description

If you would like to have your child dedicated at Southside Assembly of God Church, Complete the online child dedication application below.