Calvary Chapel Venice

BABY DEDICATION APPLICATION

Date Input

Baby's Information

Baby's FIRST Name

Baby's LAST Name

Baby's Gender

Baby's Birth date

Hospital Where Baby was Born?

Parent Information

Parent Applicant is:

Mother

Father

Guardian

Mother's FIRST Name

Mother's LAST Name

Mother's Age

Father's FIRST Name

Father's LAST Name

Father's Age

Email of Applicant Inquirer

Cell Phone Number of Applicant Inquirer

Address of Applicant Inquirer

Apartment, suite, etc.

City

State

Postal / Zip Code

Marital Status

Are you a Church Member of CCV?

Yes

No

Are you a Born Again Christian?

Yes

No

Briefly share your testimony about your relationship with Jesus Christ.

What is the significance of Dedicating your Baby to the Lord?

Personal Reference Information

Please provide the contact information of two people who know you well.
One a personal friend, the other must be a CCV Ministry Leader.

1st Reference FIRST Name

1st Reference LAST Name

Cell Phone Number of 1st Reference

Email of 1st Reference

How long have you now this person?

2nd Reference FIRST Name

2nd Reference LAST Name

Cell Phone Number of 2nd Reference

Email of 2nd Reference