February 10-11, 2018 Child Dedication Form
February 10-11, 2018 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?  * 
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 Holly Stevenson at hstevenson@cheyennehills.org, 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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