Adult Baptism Registration Form
New Harvest Christian Center Vision
A House of Great Praise & Worship
Name of the Person to Be Baptized
Prefix
First Name
Middle Name
Last Name
Suffix
Gender
Male
Female
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
New Harvest Christian Center Mission
To Reach the Unreached
Family Information
Spouse Name
First Name
Last Name
Has your spouse been baptized?
Yes
No
Will they baptized with you today?
Yes
No
List the Names and Birthdates of Child(ren)
Do you have children?
no
if yes enter information below
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Name
First Name
Last Name
Has your child(ren) been baptized?
no
if yes enter date below
Baptism Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Will they baptized with you today?
Yes
No
Check the Following to Communicate Your Understanding
*
What is the vision for your life?
What are you praying for that we could pray with you?
Is there anything that you would like us to share with the congregation as you are baptized?
Is there a special scripture you have for yourself?
Submit
Should be Empty: