Child Dedication

Child Dedication Sign Up Form

We'd love to hear from you. Fill out the form below to get started.

Child’s Full Name

Birth Date

Gender

Relationship to Child

Mother’s Full Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Email Address

Mother: Have you received Jesus as your Lord and Savior

Do you attend Impact Church at Liberty

Father’s First Name

Father’s Last Name

Address 1

Address 2

Country

City

State

Zip/Postal Code

Phone Number

Email Address

Father: Have you received Jesus as your Lord and Savior

Do you attend Impact Church at Liberty

Why do you personally want to have your child dedicated?