我们，以下签署人，即联合改革宗教会___________________区会，_________________教会的福音仆人（即牧师）、长老和执事，在主面前，真诚地、凭着无亏良心，在此声明，我们衷心相信并信服，改革宗教会认信的《比利时信条》和《海德堡要理问答》中所包含的所有教义条款和要点，以及1618-19年多特国家总会对上述教义中一些要点的解释（即《多特信经》），确实与上帝的话语完全一致。

因此，我们承诺，殷勤地教导并忠实地捍卫上述教义，不以公开讲道、教导或写作直接或间接地抵触上述教义。

我们进一步声明，我们不仅拒绝一切与此教义相抵触的错误，尤其是拒绝那些被上述大会所定罪的错误，而且愿意竭力驳斥并反对这些错误，并尽心竭力保持教会免于此类谬误。若日后我们对上述教义产生任何疑惑或不同见解，我们承诺，在未先将这些想法向牧长会、区会或大会陈明、以便由其加以审查之前，我们绝不会公开或私下通过讲道、教导或写作来提出或辩护这些观点；并且我们也随时乐意顺服牧长会、区会或大会的审判，否则，若有拒绝之举，我们将因此而立刻被革除职分。

此外，在任何时候，如果牧长会、区会或总会，在有充分的怀疑理由，并为了保持教义的统一和纯洁，认为应当针对信条、要理问答或国家总会的解释中任何特定的条款，要求我们进一步解释我们的想法，我们在此承诺在上述处罚的条件下，将始终愿意并准备好遵守这种要求，否则甘愿处在上述惩罚之下。如果我们认为自己受到牧长会或区会的不公判决，我们保留上诉的权利；直到上诉最终判决之前， 我们将顺服现有的决定和判决。

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Form of Subscription

We, the undersigned, Ministers of the Gospel, Elders and Deacons of the United Reformed congregation of __________________________ of the Classis of _________________________ do hereby, sincerely and in good conscience before the Lord, declare by this our subscription that we heartily believe and are persuaded that all the articles and points of doctrine contained in the Belgic Confession and Heidelberg Catechism of the Reformed Churches, together with the explanation of some points of the aforesaid doctrine made by the National Synod of Dordrecht, 1618-‘19, do fully agree with the Word of God.

We promise therefore diligently to teach and faithfully to defend the aforesaid doctrine, without either directly or indirectly contradicting the same by our public preaching, teaching, or writing.

We declare, moreover, that we not only reject all errors that militate against this doctrine and particularly those which were condemned by the above mentioned Synod, but that we are disposed to refute and contradict these and to exert ourselves in keeping the Church free from such errors. And if hereafter any difficulties or different sentiments respecting the aforesaid doctrines should arise in our minds, we promise that we will neither publicly nor privately propose or defend the same, either by preaching, teaching, or writing, until we have first revealed such sentiments to the Consistory, Classis, or Synod, that the same may there be examined, being ready always cheerfully to submit to the judgment of the Consistory, Classis, or Synod, under the penalty, in case of refusal, of being by that very fact suspended from our office.

And further, if at any time the Consistory, Classis, or Synod, upon sufficient grounds of suspicion and to preserve the uniformity and purity of doctrine, may deem it proper to require of us a further explanation of our sentiments respecting any particular article of the Confession of Faith, the Catechism, or the explanation of the National Synod, we do hereby promise to be always willing and ready to comply with such requisition, under the penalty above mentioned, reserving for ourselves, however, the right of appeal in case we should believe ourselves aggrieved by the sentence of the Consistory or the Classis; and until a decision is made upon such an appeal, we will acquiesce in the determination and judgment already passed.