Water Baptism Request

Your name *

Last name

Email address *

Gender *

Select…MaleFemale

Address *

HomeWorkOther

Country

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Phone number *

Phone type

MobileHomeWorkOther

Birthday *

Age *

Date of Salvation *

Parents

I understand that my child must be 5 years of age or older.

Are there any family members that wish to be baptized? If so, please list full names and ages.

What size shirt do you wear? *

A complimentary t-shirt will be provided the day of baptism

Select…SMMDLGXL2XL3XL

Submit

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