Home » Baby Dedication Request Form Baby Dedication Request Form 2017 Dedication request due by: October 2 (for October 14/15 dedication) Dates you are requesting:*October 14/15Service you are requesting:*(Time and North/South)Baby's InfoBaby's Name:*Baby's gender:*MaleFemaleBaby's Date of Birth:* Parent's InfoDad's full name:*Dad's Date of Birth:* Mom's full name:*Mom's Date of Birth:* How long have you attended CA?*Dad, please describe your relationship with Jesus:*Mom, please describe your relationship with Jesus:*What is your prayer for your baby?*Are you married?*YesNoCA service you primarily attend:*Saturday 6pmSunday 9am NSunday 9am SSunday 11:15am NSunday 11:15am SSunday Fusion 6pmI want to raise my child to know and understand the Gospel of Jesus Christ and to encourage his/her faith.* Yes, I Agree I would like to talk to a staff member to better understand the commitment that is made when a parent dedicates their child.*YesNoContact InfoHome Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone:Dad's Cell*Mom's Cell*Dad's Email* Mom's Email* Would you like to be included in our database?*YesNoKids Church Office: 323-255-2516 / 2424 Colorado Blvd. Los Angeles, CA 90041 This iframe contains the logic required to handle Ajax powered Gravity Forms.