Empowerment Life Baptism Intake
Candidate Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
example@example.com
Age (If candidate is a minor, <17 y/o)
Sex
Male
Female
Mother's Name (if candidate is a minor, <17 y/o)
First Name
Last Name
Mother's Phone Number
Please enter a valid phone number.
Father's Name (if candidate is a minor, <17 y/o)
First Name
Last Name
Father's Phone Number
Please enter a valid phone number.
The next Baptism is scheduled for September 14, 2025. Are you available to attend the virtual baptism class on September 13, 2025?
*
Yes
No
Have you been baptized before?
*
Yes
No
If so, at what age?
What does baptism mean to you, and what are your hopes for what it will bring to your life?
Emergency Contact Name and number
Signature
Submit
Submit
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