Baptism Request Form
Having a desire to follow the Lord Jesus Christ in obedience I desire to be baptized in water
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Do you understand why believers are water baptized?
*
YES
NO
Have you ever been baptized?
*
YES
NO
Date baptized if answered yes to previous question
-
Month
-
Day
Year
Date
Have you been Born Again having ask Jesus Christ to forgive you of your sins?
*
YES
NO
Date you were saved? (If Known)
-
Month
-
Day
Year
Date
Date you are requesting to be baptized
*
-
Month
-
Day
Year
(date must agree with church calendar and scheduling of services)
Submit
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