November 11-12, 2017 Child Dedication Form
Full name and date of birth of child being dedicated (ex. John Smith 10/22/2014, Jane Doe 06/21/2013)
Which weekend service would you like to dedicate your child during?
6 pm - Saturday
9 am - Sunday
11 am - Sunday
Parent(s) full name
Mailing address (include city, state and zip)
Your Email Address
Phone number (please include area code)
By completing this form you approve of the statements listed below. If you do not approve, please contact Georgeann Wearin at email@example.com, thank you!
I hereby give Cheyenne Hills Church (CHC) permission to take photographs and video of me, either by myself or in a group, for the purpose of publicity, advertising, or publishing.
I hereby give CHC permission to use my name, likeness, voice, and biographical material and exhibit/distribute, in whole or in part, without restrictions/limitations.
I hereby release and discharge CHC from any and all claims arising out of use of the photos/videos.
I am the legal guardian of said person(s). I have read the foregoing document and fully understand its contents.
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