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Family Dedication Registration Form

Father’s Name:

Father's Cell Phone:

Mother’s Name:

Mother's Cell Phone:

Address: (required)

Home Phone Number: (required)

Primary Email Address (required)

Children To Be Dedicated

First, Middle, Last Name Birthdate (MM/DD/YYYY) Male or Female

Please select which Family Dedication date you would like to attend: (required)

Why do you desire to participate in the Family Dedication at Hollywood Community Church?

Have you as a Father committed your life to Jesus Christ and trusted Him for salvation?

Explantion

Have you as a Mother committed your life to Jesus Christ and trusted Him for salvation?

Explantion

Are you single?

Are you married parents to the child/children being dedicated?

When were you married?

You can enter any additional questions or comments below:

For more information about Family Dedications including FAQ’s Click HERE.

To download a PDF version of this form Click HERE.

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