Church App Suite :: Church Form

Child Dedication Form

Please complete this form if you would like to have your child dedicated at Centerpoint. If you are dedicating more than one child, fill out a separate form for each. Please be advised that your requested dedication date is not confirmed until you receive a confirmation email from Centerpoint. We ask that requests be submitted at least 2-3 weeks prior to desired dedication date. Once we receive your form, we will schedule a time for you to meet with Celia Thorington, Director of Children’s Ministry, as well as with our technical team to record your dedication video. Please return form to Celia Thorington by email at celia@centeringlives.com or by fax 334-356-4695.

Child's Name

Gender

Date of Birth (mm/dd/yy)

What is your relationship to the child?

Mother's Name

Phone Number

Email

Father's Name

Phone Number

Email

Address

City, State Zip

Are both parents Christians?

Are both parents members of Centerpoint?

Your First & Last Name

Additional Guardian First & Last Name

Your Relationship to The Child (grandparent, aunt, uncle, etc.)

Phone Number

Email

Address

City, State Zip

Are you a member of Centerpoint?

Due to the spiritual nature of questions asked during our Child Dedications, it is helpful for us to understand the marital status/living situation of the household. Which of the following best describes the parents'/guardians' situation?

Please explain

Preferred Dedication Date & Service Time

Do you need seats reserved for friends/family? If so, how many?

Please share any special circumstances surrounding your child.

(for example: adoption, infertility, special needs, special meaning to name of child, etc.)

Please share a few of your hopes, dreams and aspirations for your child.

Write out a special blessing for your child, incorporating what you see in them and what you encourage them to pursue as God guides and provides.

Who would you like to preform your Child Dedication?

Please specify