Life Touch Community Church - Plainfield

BABY DEDICATION REQUEST FORM

Child's First Name

Child's Last Name

Child's Date of Birth

Father's First Name

Father's Last Name

Mother's First Name

Mother's Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Mother: Have you received Christ as your personal Savior?
Yes
No

Father: Have you received Christ as your personal Savior?
Yes
No

Are you a member of LTCC
Yes
No

Message

Father's Signature - (First Name)

Last Name

Mother's Signature - (First Name)

Last Name