Water Baptism Application

Water Baptism Application
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState

Zip Code
E-mail
Phone Number

Area CodePhone Number
Date of Birth
Are you a member or regular attender of JCC?

YesNo
If you are 18years old or younger, please have one of your parents submit this application.
Written Testimony
How and when did you come to know the Lord Jesus Christ as your personal Savior?
Should be Empty: