Baptism Registration Form

Full Name *

First Name Last Name

E-mail *

T-Shirt Size: *

Phone Number *

Area Code Phone Number

Date of Birth *

Month Day Year

Gender? *

Male Female

Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Please state briefly how and when you placed your faith in Christ as Savior and began to follow Him with your life: *

Do you believe you are going to Heaven? Why do you believe that? *

Why do you want to be baptized? Have you been baptized before? Please explain *

Baptism is a public declaration symbolizing death to our old way of life and entering in the new life we have received in Christ. Though not perfect, does your life today reflect the change Christ has made in you? *

Are you being baptized with any family members? If so, who?

Please Select One:

I am ready to schedule my baptism. I need to speak with someone before I am ready to schedule my baptism.

If necessary, please select a Baptism Orientation date:

May 20, 2020 at 6:30 PM room 203B

Children's (up to 5th grade) Baptism Class will be held November 7th at 9:30 & 11

9:30AM 11:00AM

If ready to schedule please choose a date for Baptism:

Sunday November 21, 2021 Thanksgiving PM Service

What service would you like to be baptized at?

8:00 AM 9:30 AM 11:15 AM

We are honored to give you a bible on the day of your baptism. Would you like to receive a bible?

Yes No