Name (Required)

Email Address (Required)

Your Phone Number (Required)

Gender (Required)

Today's Date (Required)

Address

Do you believe Jesus died for your sins, was buried in a grave and 3 days later rose again? (Required)

Which service would you like to be baptized? (Required)

When do you want to be baptized? (Required)

How would you like your name to appear on your baptism certificate? (Required)

Are you over 18? If not please continue to fill out this form but please speak to our children's Pastor or youth Pastor prior to your baptism. (Required)

If you are under 18, please list your current age in order to put you in contact with the correct Pastor.