Please complete the form below if you are interested in dedicating your child. Please Note: There is a compulsory 2-hour training session that you have to complete. We will email you the next date once we have received your form.

Child's Surname *

Child's Full Names *

Date of Birth *

Place of Birth *

Father's Name & Surname

Mother's Name & Surname

Mobile No *

Email

Home Address

Suburb

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