Child Dedication Form

Child Dedication Form
Which campus do you attend?

Lafayette Campus Throggs Neck Campus
Child's Information
Full Name *

First Name Middle Name Last Name
Birth Date

Month Day Year
Gender *

Female Male
Parent's Information
Marital Status

Single Married Widowed Divorced
Mother's Name

First Name Last Name
Mother's Mobile Phone

Area Code Phone Number
Mother's E-mail
Father's Name

First Name Last Name
Father's Mobile Phone

Area Code Phone Number
Father's E-mail
Address

Street Address Apt. #
City, State

City State / Province
Zip Code
Have you accepted Jesus Christ as your Personal Savior?

Yes No
Have you been baptized?

Yes No
How long have you been attending LTF?
Should be Empty: