Name

First Name

Last Name

Phone

(###)

###

####

Please select one

I have accepted Jesus as my Lord and Savior.

I have not accepted Jesus as my Lord and Savior but would like to do so.

I have not accepted Jesus as my Lord and Savior and am not interested in doing so.

Church Affiliation

Please enter the name of your church home. If you do not have one, please type N/A.

Will other members of your family/household be joining you to be baptized?

If yes, please list each person's name and age.

Baptism Class

Baptism Class will be held Wednesday, November 27th at 6:30p before the baptism service.

I will be present.

I will not be present

Your registration has been received.

We will send you a reminder of the date and time you selected for baptism class. Please be sure to mark your calendar to ensure you are present.

Baptism Service will be held Wednesday, August 28th at 7:30pm.