Children's Baptism Registration Form

Children's (K-5th Grade) Baptism Registration Form
Full Name (This form is for Children K-5th Grade)*

First NameLast Name
Parent or Guardian E-mail*
example@example.com
T-Shirt Size:*
Phone Number*

Area CodePhone Number
Date of Birth*

MonthDayYear
Gender?*

MaleFemale
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
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.
Please check to attend Parent/Child baptism class:*

Sunday, February 9, 2025Sunday, May 4, 2025
If ready to schedule please choose a date:*

Sunday, February 23, 2025 - 8:00AMSunday, February 23, 2025 - 9:30AMSunday, February 23, 2025 - 11:15AMSunday, May 18, 2025 - 8:00AMSunday, May 18, 2025 - 9:30AMSunday, May 18, 2025 - 11:15AM
Pastor you would prefer to baptize you:

Pastor Caleb WaldropPastor Eric HammenPastor Blake LaRussa
We are honored to give you a bible on the day of your baptism. Would you like to receive a bible?

YesNo
Should be Empty:

Children's (K-5th Grade) Baptism Registration Form