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Child Dedication Registration
Thank you for your interest in participating in a Child Dedication!
Please complete the registration information below. After submitting this form, we will reach out with dates for the next Preparation Class as well as information for what to expect.
If you have any questions before then, please contact
Cortney Spotts
.
SITE
*
Which Blackhawk site/venue does your family attend?
-- Select --
Brader Way - Chinese
Brader Way - Eastside Live
Brader Way - Gospel Fusion
Brader Way - Traditions (meets in gym)
Downtown
Fitchburg
*
Which service time do you usually attend?
-- Select --
9:00 am
10:45 am
4:30 pm (Brader Way only)
CHILD'S INFORMATION
Please enter the information as you would like it to be read.:
*
Child's First Name:
*
Child's Middle Name:
*
Child's Last Name:
*
Child's Birth Date
(mm/dd/yyyy):
PARENT INFORMATION
*
Parents' Names:
*
Street Address:
*
City:
*
State:
*
Zip Code:
*
Email Address:
*
Phone Number:
SIBLING INFORMATION
Please indicate siblings' names and ages below. Write X if none.:
*
Siblings:
THANK YOU!
:
Submit Form