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

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.