Child Dedication Application

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Child Dedication Application

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Child Information

(Please type full name of child(ren) as you would like it to appear on dedication certificate.)

Name:* Male  FemaleBirth Date:*  
Name:   Male  FemaleBirth Date:    


Parent Information

(Please type full name of parents, as you would like them to appear on the dedication certificate.)

Mother:* 

Father:* 

Email:* 

Day Phone:* 

Evening Phone:* 

Address: 

City, State, Zip:* ,  

What is the best way to contact you:* 

Are you married:* Yes  No      Wedding date: 



 MotherFather
Are you a Born-again believer in Jesus Christ:
How long have you been a Christian:
Do you regularly attend the Rock Church:
How long have you been attending:
Have you been baptized:
Have you completed the Effective Parenting in a Defective World class:
Are you currently involved with any Rock ministries:
If yes, please list:  
Are you in a Small Group:  Facilitator's name:  
Do you have a church affiliation prior to attending the Rock Church?  If yes, please name the church:


Additional Information

Please list the people who will be joining you on stage during the ceremony.  Include the names and ages of any siblings of the child being dedicated if they will be joining you on stage.  Please identify the person by their relation. (I.e. sister= Ashley 6 yrs old, grandmother= June, etc.):

Relation, name: 

Relation, name: 

Relation, name: 

Relation, name: 



Please complete the information below:*

When a child is dedicated at the Rock Church, the child is not the only person being dedicated; the parents are also being dedicated. The idea is that the parents are committing to raise their children in a Bible-believing home where biblical principles govern the household and are passed down. Thus, the following requirements should be noted:

  1. At least one parent must be a born-again believer in Jesus Christ.
  2. Neither parent participating in the dedication may be actively involved in adultery.
  3. A single parent must be committed to sexual purity (may not participate in pre-marital sex currently or in the future).
  4. Neither parent participating in the dedication may be involved in drug use or alcohol abuse (drunkenness, etc.)

If you have any questions about the following requirements or currently find yourself unable to fulfill them, please contact Danielle Demko directly at 619.226.7625 x280.  We would love to help you with anything preventing you from fulfilling these requirements.

  Yes, we (I) have read the above requirements and agree that we (I) meet them.

  We do not meet the requirements above.

The Rock Photo Ministry would like to offer you a free 5x7 of your child's dedication and will make every effort to be present. Your permission is required for this picture to be taken. Please check the appropriate line below and sign:

  Yes, we would love a free 5x7 of our child's dedication. We understand that our picture may be displayed at a Quarterly Rock Photo Gallery on one of the sanctuary walls.

  No thank you, we do not wish to have a photograph taken.

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