Altar Experience Card

Altar Experience Card

Altar Experience Card for Mobile Devices (Revision: 11/05/2024)
Date*

MonthDayYear
Date
Service*
Name of person who had an Altar Experience*

First NameLast Name
Address of person who had an Altar Experience

Street Address

Street Address Line 2

CityState

Zip Code
Home Phone
Please enter a valid phone number.
Mobile / Cellular Phone
Please enter a valid phone number.
Email
example@example.com
Male / Female*

MaleFemale
Demographic*

Single (31+)MarriedYoung Adult (18-30)YouthChild
Birthdate

MonthDayYear
Date
Date Repented

MonthDayYear
Date
If NOT getting baptized today, have you ever been baptized in the name of Jesus by full immersion in water?

YesNoNot sure
Date Baptized

MonthDayYear
Date
Date Received the Holy Ghost

MonthDayYear
Date
Is this a re-fill?

YesNo
How did you hear about our church?
Friends or relatives in this church
Person(s) who invited you to church
Have you attended a Connection Group from our church?

YesNo
Which groups have you visited?
Are you interested in a Home Bible Study?

YesNo
Altar Assistant Name*

First NameLast Name
Person Filling Out This Altar Form*

First NameLast Name
Comments:
Photo of person

Cancelof
Should be Empty: