Water Baptism Class Registration Form

Water Baptism Application
Applicant's Name*

First NameLast NameSuffix
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail*
example@example.com
Phone Number*
Format: (000) 000-0000.
Parent/Guardian Information

(If under 18 years of age)
Relationship to the Applicant
Name

First NameLast Name
Phone Number
Format: (000) 000-0000.
Alt. Phone Number
Format: (000) 000-0000.
YESNO
How long have you been attending Highland Church? *
YESNO
Additional Comments
Please upload a current profile photo of yourself*

Cancelof
Should be Empty: