Baby/Child Dedication Form February 22, 2026
February 22, 2026 @ 10am | Please fill out this form and click submit
Full Name of Child
*
Date of Birth
*
Gender
*
Please select one option.
Male
Female
Select Option
Male
Female
Name Of Parents / Gardian
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Cell Phone
*
Email
*
This address will receive a confirmation email
Child T-Shirt / Baby Onesie Select Size Below
*
Please select one option.
T-Shirt
Onesie
Select Option
T-Shirt
Onesie
Size of Child T-Shirt or Baby Onesie
*
Photo/Media Consent
I understand that photos and/or video may be taken during this event. I give Central Assembly of God permission to use these images in church publications, on the church website, and on social media for promotional purposes.
Check one
*
Please select all that apply.
Yes, I consent
No, I do not consent
Submit
Description
February 22, 2026 @ 10am
Please fill out this form and click submit
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