First Name
*
Last Name
*
Address
*
City
*
State
*
ZIP
*
Birth Date
*
Phone Number
*
Email
______________________________________________________
Please state briefly how and when you accepted Christ as your Savior:
*
Why do you want to get baptized? Have you been baptized before (since becoming a Christian)?
*
______________________________________________________
Please Select One:
*
I am ready to schedule my baptism.
I need to speak with someone before I am ready.
Submit
Once we receive your registration form, we will contact you to schedule your baptism. If you have any other questions or concerns regarding baptism, please contact us at 940-969-2427.
Should be Empty: