Child Dedication Questionnaire

1
Please enter your first and last name.* This field is required.
First Name
Last Name
2
Please enter your date of birth.* This field is required.
Date
Year
Month
Day
3
Please enter your mailing address.* This field is required.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Please enter a valid email. * This field is required.
example@example.com
5
Please enter a valid phone number.* This field is required.
Area Code
Phone Number
6
What CTK Campus do you normally attend?* This field is required.
Bellingham
Ferndale
Sudden Valley
North Bay
Downtown
7
Are you married or single?
Married
Single Parent
Other
8
Before we proceed, we would love to talk and learn more about your family and how we can best walk along side you in your parenting journey. Please contact Pastor Angel Finsrud by phone at (360)469-1995 or via email at angelf@ctk.church.
9
We agree to be fully devoted followers of Jesus, committed to serving Him & His church.
YESNO
10
We want to ask God to help us raise our child(ren).
YESNO
11
We are committed to building our relationship based on biblical values and principles.
YESNO
12
How long have you been married?
13
Please enter your spouse's name.
First Name
Last Name
14
Please enter your spouse's date of birth.
Date
Year
Month
Day
15
I agree to be a fully devoted followers of Jesus, committed to serving Him & His church.
YESNO
16
I want to ask God to help me raise my child(ren).
YESNO
17
I am committed to building any future relationship based on biblical values and principles.
YESNO
18
I am committed to raising & training my child(ren) in a Godly way, through faithful prayer & support of my church body.
YESNO
19
Child's Full Name. * This field is required.
20
Child's Date of Birth. * This field is required.
Date
Year
Month
Day
21
Child's Gender * This field is required.
Male
Female
22
Will you be dedicating a second child?* This field is required.
YESNO
23
Second Child's Full Name
24
Second Child's Date of Birth
Date
Year
Month
Day
25
Second Child's Gender
Male
Female
26
Child(ren)'s Names: Is there a special reason or meaning for the names you have chosen for the child(ren) you are dedicating? Is there a special verse you have chosen for the child(ren) you are dedicating? * This field is required.
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27
Names & ages of other children in your household. If none, please put N/A in the box. * This field is required.
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28
Please give us a list of important events/seasons in your family's history.* This field is required.
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29
How does Jesus fit into your everyday life as a family?* This field is required.
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30
Who are the people (names & relationship to you) that you have asked to be part of the dedication service and to walk this journey of godly parenthood with you?* This field is required.
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31
Is there anything else you think we should know?
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32
Optional: We would love to see your family! Please upload a photo of your choice.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
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