Decision Counseling Form
Please complete the form below to let us know the decision you made at Fields of Faith!
Church that I attend / Church I would attend if someone invited me:
*
Please Select
I DON'T HAVE A CHURCH
Allen Temple Missionary Baptist Church
Calvary Missionary Baptist Church
Calvary Baptist Church
Celebration Church - Humphrey
Christ Connect Church
Family Christian Fellowship
Faith Baptist Church
First Assembly of God - Dewitt
First Baptist Church - Almyra
First Baptist Church - Dewitt
First Baptist Church - England
First Baptist Church - Stuttgart
First Methodist Church - Dewitt
First Methodist Church - Stuttgart
Harvest Church
Landmark Baptist Church
Lively Stone Pentecostal Church
Macedonia Baptist Church
Southside Baptist Church
CHURCH NOT LISTED
If your church is not listed what is the name of your church?
City of your church
What Decision did you make?
*
Salvation / First-time commitment to follow Jesus Christ
Rededication of faith
I have questions about Jesus
Full Name
*
First Name
Last Name
Cell Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Can We Text or Call You?
*
Yes
No
School:
*
Please Select
Brinkley
Carlisle
Clarendon
Dewitt
England
Hazen
Stuttgart
SCHOOL IS NOT LISTED
If Your School is not Listed, What is the Name of Your School?
Current Grade:
*
Please Select
4
5
6
7
8
9
10
11
12
College
Adult
DO YOU HAVE A BIBLE?
*
YES
NO
Congratulations! Be sure to tell your Coach, Church Youth Leader and/or Parent(s) of the decision you made tonight to follow Jesus! Click Submit to learn the FIRST STEPS in your decision to follow Jesus.
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Submit Decision
Should be Empty: