Baptism Form

1
Name* This field is required.
First Name
Last Name
2
Email* This field is required.
example@example.com
3
Phone Number* This field is required.
Area Code
Phone Number
4
I want to get baptized because...* This field is required.
I just gave my life to Jesus
I am rededicating my life to Jesus
I got baptized a long time ago, but feel led to do it again
5
Additional Comments
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Large
Normal
Small
Ok
Ok
Should be Empty: