Parent/Guardian Information

Please list the names of the parents/guardians who will be listed on the certificate. Please only list those who will participating in the ceremony and who live in the same residence with the child(ren).
First Name of Parent/Guardian 1 *

Last Name of Parent/Guardian 1 *

Full Name of Parent/Guardian 2 (if applicable)

Primary Phone Number Contact *

Child(ren) Information

Please enter the (correctly spelled) names of the children who will be participating in the Family Dedication ceremony. If you have previously dedicated children, you may enter them as well here. Just to clarify, these are the names we will read during the FD service!
Full Name of Child 1 *

How old is {{answer_13413077}}? *

Full Name of Child 2 (if applicable)

Age of Child 2

Full Name of Child 3 (if applicable)

Age of Child 3

Full Name of Child 4 (if applicable)

Age of Child 4

Are there any names of your children that require pronunciation help? If so, please list below with a pronunciation guide. :)

Service Selection

Here we'll collect the information to determine which service you'll participate in.
Which Weekend Gathering Would You Like to Participate In? *

Are you flexible in your service selection? *

Have you already taken the Family Dedication class at Emergence in the past? (if so, you are not required to attend again) *

Great! Thanks for filling out the form!
We'll be in touch with final confirmations shortly!
Just a reminder, if you have not yet taken the Family Dedication Class, at least one parent/guardian is required to attend.
If you could not attend, a make-up class will be provided!

If you have any questions, feel free to reach out to Robin Allison at