JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
BABY & CHILD DEDICATION
SET APART FOR THE LORD'S USE...
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Date Of Filling In Form
*
MM
/
DD
/
YYYY
Child's Full Names & Surname
*
Your answer
Child's Nickname (If Applicable)
Your answer
Gender of Child
*
Male
Female
Required
Birth Date of Child
*
MM
/
DD
/
YYYY
Child's Age
*
Your answer
Parent 1: Name & Surname
*
Your answer
Parent 1: Contact Number
*
Your answer
Parent 1: Email
*
Your answer
Parent 2: Name & Surname (If Applicable)
Your answer
Parent 2: Contact Number (If Applicable)
Your answer
Parent 2: Email
Your answer
Are You CCM Members?
*
Yes
No
Interested
Please Select:
Yes
No
Interested
Please Select:
Please Select The Desired Dedication Date (Our Admin will confirm availability)
*
MM
/
DD
/
YYYY
Next Step
Our friendly Admin will get in touch upon submission of this form!
They will request a high resolution photograph of your child.
You can also mail it directly to
admin@cornerstonem.co.za
with the Subject: 'Child Name' Dedication Pic...
For Admin Use Only
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
