Baptism Form
Name
First Name
Middle Name
Last Name
Email
example@example.com
Phone Number
-
Area Code
Phone Number
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Requested for Baptism
-
Month
-
Day
Year
Date
During which service will the baptism take place?
9:00AM
11:00AM
Can we post your baptism on our website and Facebook page as part of our sermon video?
Yes
No
Do you want a disc with your baptism video on it?
Yes
No
What family will be present the day of your baptism?
Anything you would like to say prior to being baptized:
Any Bible verses you would like mentioned:
What led you to the decision of baptism?
What do you expect from your baptism?
Please verify that you are human
*
Submit
Should be Empty: