Baptism

Name of Candidate:*

First Middle Last

Date of Birth:*

Age*

Age Range*

All children must be at least 7 years old.

Children (7-11)
Adult

Which baptism date are you registering for?*

June 30th

Marital Status:*

Single
Married
Divorced
Widow

Gender:*

Male
Female

Address:*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Phone*

Is this your first time being baptized?*

Yes
No

I am trusting Jesus Christ alone for my salvation, desiring that He be Lord of every area of my life.

Please type your initials if you agree.

I want to be baptized as a public testimony and I: (1) Confess that Jesus Christ is my Savior and Lord (2) Desire to follow Christ in death to self and to walk with Him in the newness of the Spirit-filled life.

Please type your initials if you agree.

Picture of Baptism candidate*

Please upload a good quality image to be displayed on the monitors.

Max. file size: 256 MB.

The candidate for baptism is a minor (must be at least 7 years old):*

Yes
No

If candidate is a child, parents please complete information below

Father's Name:*

First Last

Mother's Name:*

First Last

I have discussed water baptism with my child.*

Please type your initials if you agree.

By typing your name here, you consent to your child's decision to undergo water baptism by immersion.*

Water Baptism

If candidate is a child, parents please complete information below

JOIN US ON SUNDAY!

Service Times:

Location:

Email Address: