Application for Baptism
Full Name for Certificate
*
First Name
*
Last Name
*
Email
*
Phone
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If you are under 18, do you have your parents' permission to be baptized?
*
Yes
NO
Parents' Names (if under 18)
I accepted Jesus Christ as my Lord and Savior (date, approximate okay):
-
Month
-
Day
Year
Date
I understand that baptism is a form of obedience and public expression of my faith in Jesus Christ
*
Yes I do understand
Would like to know more what it means
My Testimony
Submit
Should be Empty: