Baby Dedication Form
Potomac Valley Assembly Church
Why do we dedicate babies? We, as Christians, have a tremendous responsibility given to us when the Lord blesses us with a child. By doing so, He entrusts us with the responsibility of raising that child in the way of the Lord and establishing early in his or her life, a foundation built upon Jesus Christ. It is a wonderful opportunity to make a public declaration that you will raise your child in a loving Christian home. What exactly is involved in “dedicating” your child to the Lord? Scripture tell us that children are a heritage from the Lord. He gives them to us to bless us, and because of this, we must be willing to give them back to Him. We too must be willing to totally submit our children to the will of our Father. A perfect example of “dedicating” a child to the Lord is given to us in I Samuel 1:11, 26-68. Hannah, being barren (or without child) for many years, was weeping before the Lord because of her barrenness. As she was weeping, she made a vow to God. “And she made a vow, saying, ‟O LORD Almighty, if you will only look upon your servant’s misery and remember me, and not forget your servant but give her a son, THEN I WILL GIVE HIM TO THE LORD ALL THE DAYS OF HIS LIFE...” (I SAMUEL 1:11)God honored Hanna’s request and gave her a son named Samuel. Hannah then, in keeping her vow, dedicated (or set apart) Samuel unto the Lord. We see here a beautiful example of what our attitudes should be towards our children and their relationship to God. We are to do the most we can to “set apart” our children to God until the day that they can make their own choice. By dedicating your children to the Lord, you are making a vow to raise them in His ways.
Please read: Communication regarding baby dedication arrangements must be made with the parent or legal guardian presenting the child or children. Please be aware that only a couple committed to Christ and married (a man and a woman) or a single parent committed to Christ can participate in a baby/child dedication. Couples or single parent’s living with someone out of wedlock will not be considered. Baby Dedications are currently scheduled for the 11:00 a.m. service. You will receive a confirmation email or phone call once you have turned this form into the office no less than two weeks before the next scheduled baby dedication. See bulletin and church website for dates. We are excited to share in this special time for you and your family! Please print clearly and legibly.
Today Date:
Child’s Date of Birth:
Child’s Gender: Boy Girl
Child’s name (First, Middle & Last Name) as you would like it to appear on the Dedication Certificate:
Address:CityStateZip
Dad’s Email:
Mom’s Email:
Home Phone:
Dad’s Work Phone:
Dad’s Cell Phone:
Mom’s Work Phone:
Mom’s Cell Phone:
Father’s Information
Name (First and Last):
Are you currently attending Potomac Valley Assembly Church? Yes or No
Are you a member of PVA Church? Yes or No (If yes, what year did you become a member?)
Are you a member of another church? Yes No (If yes, what is the name of that church and address)
For how long have you attended PVA Church?
Briefly describe your Christian experience - How did you become a Christian and what does this mean to you?
Mom’s Information
Name (First and Last Name):
Are you currently attending Potomac Valley Assembly Church? Yes or No
Are you a member of PVA Church? Yes or No (If yes, what year did you become a member?)
Are you a member of another church? Yes or No (If yes, what is the name of that church and address)
For how long have you attended PVA Church?
Briefly describe your Christian experience –When/How did you become a Christian and what does this mean to you?
Additional Information
How long have you been married?
Please list any other family members or special guests who will be joining you on the platform who are not a part of your immediate family (spouse and children). Name(s) and Relationship:
Briefly describe what baby/child dedication means to you:
I verify that the information I have provided in this form is accurate to the best of my knowledge.
Mom’s Signature:
Dad’s Signature:
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