| Request Form | |
| The parents | |
| and | |
| have a desire to have their child(ren) | |
| dedicated back to God. In doing so, they acknowledge being responsible in raising the child(ren) in a way pleasing to God, by teaching him/her His ways and praying earnestly for him/her. The above parents request their child to be dedicated at Faith Heritage Church under the leadership of Pastor James T. Jones, Jr. | |
| The god-parents, | |
| and | |
hereby pledge their support of the above named child, to assist in guidance in Christianity, to support the parent in helping to raise the child in a Christian manner and lovingly praying for the child throughout his/her upbringing. |
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| Parent Name Print Sign | |
Date |
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| God-parent(s) Print Sign | |
Date |
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| Submit | |