Water Baptism Application Form
Water Baptism Date
*
/
Day
/
Month
Year
Name
*
First Name
Last Name
Gender
*
Male
Female
Title
Dr.
Mr.
Mrs.
Miss
Date of birth
*
/
Day
/
Month
Year
Age
*
Martial Status
*
Single
Married
Divorced
Widowed
Physical Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Email Address
*
Please answer the following questions:
Do you attend Miracle Life Family Church?
*
Yes
No
Which Connection Group are you a member of?
1. Have you accepted Jesus as your saviour?
*
Yes
No
2. Give us a brief testimony about your salvation
*
3. Have you ever been baptised by immersion in water before?
*
Yes
No
Children Parental Permission
Parents' Name
First Name
Last Name
Phone Number
-
Area Code
Phone Number
Email
example@example.com
I
parent's name here
have discussed water baptism with my child
child's name here
.
Please select one:
I do consent to his/her decision to undergo Water Baptism.
I do not consent to his/her decision to undergo Water Baptism.
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