Sunday, Sept. 23

Father's Full Name *

Mother's Full Name *

Child's Full Legal Name *

Home Phone Number *

Cell Phone Number *
Please indicate whose cell phone number is entered

Address *

City *

State *

Zip *

Family Email Address *
Please indicate whose email address is entered

Child's Birthdate *

Birth Hospital Name *

Birth City and State *

Please select your preferred service time *
This is on a first response basis and times are not guaranteed 9:30 Service11:15 Service

Yes I have reviewed the Photo/Video Release Form. By registering online, I understand and agree to the terms. *

NOTE: Parents must attend a First Steps class Sept. 15, 9-11 am hosted by David Klippert-Rowe, our Childrens Ministry Pastor. This class is held in The Chapel and will help parents understand the commitment they are making during the dedication ceremony. Child-care is provided during the First Steps class as long as you pre-register your children

Thank you for registering online. We will contact you to let you know when your registration has been received.