Baptism Registration
Please complete this baptism registration form in order to receive your BOLCC baptismal certificate and "I have Decided" T shirt.
Name
*
First Name
Last Name
(Baptisms are on EVERY 3rd Sunday of the month) Date requested
*
-
Month
-
Day
Year
Date Picker Icon
T-Shirt Size
*
Small
Medium
Large
Extra Large
1X
2X
3X
T-Shirt Size
Gender
Please Select
Male
Female
Please select your gender
Date of birth
*
-
Month
-
Day
Year
Date Picker Icon
Member of Bread of Life Community Church?
*
Yes
No
Address
*
City, State, Zip
*
Phone Number
*
E-mail
*
Please enter your email address to be given instructions on Baptism
Please remember to bring: A
change of clothes and a towel.
Notes or questions
Submit
Should be Empty: