First Name *

Middle Name *

Last Name *

Date of Birth *

Gender *

Mothers First and Last Name *

Fathers First and Last Name *

Phone Number *

Email Address *

Home Address *

Are You a Member of Rehoboth Ministries? *

If you are not a member of Rehoboth, Are you a member of a church family? If Yes please name it: *

Why do you want to dedicate your child to the Lord? *

Do you understand the difference between baby dedication and baptism? *

Are you willing to raise your child in a Christian home and teach them about Jesus? *

Do you agree to partner with the church to help support your child’s spiritual growth? *