Child Dedication – Spring Valley Church

Contact Us Child Dedication

Your Name:*
First Last
Your Email:*
Your Phone Number:*
Your Mailing Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Please submit each child's information separately for each child to be dedicated.
Child's Name:*
First Last
Child's Date of Birth:*
Date Format: MM slash DD slash YYYY
Hospital Name:*
Hospital Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 1's Name:*
First Last
Parent 2's Name:
First Last
Parents' Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parents' Phone Number:*
I would like to request a dedication for a second child:*
- Yes
- No
Child's Name:*
First Last
Child's Date of Birth:*
Date Format: MM slash DD slash YYYY
Hospital Name:*
Hospital Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 1's Name:*
First Last
Parent 2's Name:
First Last
Parents' Address:*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parents' Phone Number:*
I am a:*
How long have you been attending?*
Have you accepted Jesus as your personal Savior?*
- Yes
- No
Do you consider Child Dedication a long term investment in your child?*
- Yes
- No
Please indicate the service time you would prefer. (We will try to accommodate your request, but we cannot guarantee the service time requested)*
Additional Comments:
By submitting this request, you agree to be contacted via email. Please add the domain '@springvalleycog.com' to your safe senders list. Thank you.

How to Find Us

Address:: 2727 Old Pricetown Road
Temple PA, 19560
E-Mail:: info@springvalley.church

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