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Please provide the parents' full names. These will be printed on the Certificate of Dedication.

Consent Agreement for Media
By submitting this form I hereby consent and agree for me and/or my child(ren) to be filmed by the CityLife Church media team and for my and/or my child(ren)'s image and likeness to be shown in video promotions on the screens at CityLife Church and the CityLife Church website. I understand I will receive no compensation for this filming and the footage may be used in perpetuity.
Privacy Statement: Our complete Privacy Policy is available at www.citylife.church/privacy.