PSD Form | Jesus Reigns Ministries

Child Details

Child's Complete Name

Date Of Birth
/ /

Age

Gender:

Place Of Birth

Nationality:

Child's Father Details

Name Of Father

Church Member? Yes or No?

if not please write your church's name & address

Home Address

Contact

Email Address:

Date Of Birth
/ /

Age

Place Of Birth

Profession

Employed At

Contact #:

Child's Mother Details

Name Of Mother

Church Member? Yes or No?

if not please write your church's name & address

Home Address

Contact

Email Address:

Date Of Birth
/ /

Age

Place Of Birth

Profession

Employed At

Contact #:

Other Details

Date Of Dedication

Time

Dedication Venue

MOTIF/Theme

OFFICIATING MINISTER

Option 1 - REV/PTR

Option 2 - REV/PTR

Remarks

By checking box, I state that I have read and understood the Terms and Conditions.