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?
*Which service time do you usually attend?


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!