Child Dedication Form – Mount Zion, Greensboro

Today's Date *

Are you the parents, legal guardians or grandparents of the child being dedicated? *

Yes

If the answer to this question is no, please have parents, guardians or grandparents complete this form.

If the answer is yes to the above question,then answer the following question. Are you members of Mount Zion? *

Yes

Name of Person completing this form (First & Last) *

Email of Person completing this form *

Phone Number of Person completing this form *

Please select the desired month of the the dedication

Child's First Name *

First

Child's Last Name *

Last

Date of Birth *

Mother's Name (First & Last) *

Father's Name (First & Last)

Covenant Parent's Name (First & Last)