Application for Baptism

First Name *

Last Name *

Age *

Gender *

Mailing Address *

Email Address *

Phone Number *

Are you 18 or over? *

Who is baptism requested for?

Who are you completing this application for? *

If you are requesting baptism for someone besides yourself, please provide their name, age (if child), and relationship to you.

Have you or the person(s) you are requesting baptism for accepted Jesus Christ as your (their) personal Lord and Savior? *

Yes

If yes, when (provide date)

Have you ever been baptized in water before? *

Yes

If yes, when (provide date)

Briefly explain why you wish to be baptized:

We will want to meet and discuss your request for baptism. Please provide us with some days and times you would be available to meet within the next two weeks below: