Child Dedication Form • C3 Church Darwin

First Name *

Last Name *

Date of Birth *

Gender *

What Service Time would you like? *

Mother's Full Name *

Mobile Number *

Email Address *

Father's Full Name

Mobile Number

Email Address

For siblings not being dedicated please enter below:

Sibling #1 Full Name

Date of Birth

Gender

Sibling #2 Full Name

Date of Birth

Gender

Sibling #3 Full Name

Date of Birth

Gender

Sibling #4 Full Name

Date of Birth

Gender

Sibling #5 Full Name

Date of Birth

Gender

Sibling #6 Full Name

Date of Birth

Gender

Thank you for registering your child for our upcoming dedications!

Please email a current good quality photo of your child to info@c3darwin.com so we can celebrate them on the day.