BAPTISM REQUEST FORM

Baptism Request Form

BAPTISM CANDIDATE'S NAME *

NAME *

WHAT DATE (MUST BE A SUNDAY) WOULD YOU LIKE THE BAPTISM TO TAKE PLACE? (MM/DD/YYYY) *

WHAT SERVICE TIME IS PREFERABLE FOR YOUR FAMILY? *

9:30 am

11:00 am

Either is fine

ENTER CANDIDATE'S NAME EXACTLY AS IT SHOULD APPEAR ON THE BAPTISM CERTIFICATE: *

WHICH PASTOR WOULD YOU PREFER TO PERFORM THE BAPTISM CEREMONY? *

Kevin Corey (NextGen Pastor)

Dave Rhodenhizer (Senior Pastor)

SCHOOL GRADE? *

HAS THE BAPTISM CANDIDATE MADE A PROFESSION OF FAITH IN JESUS CHRIST? *

Yes (see next field)

Unsure

IF YOU ANSWERED "YES" ABOVE, PROVIDE THE DATE, AGE, OR ANY INFORMATION THAT PERTAINS TO THE CANDIDATE'S PROFESSION OF FAITH: *

PARENT/GUARDIAN NAME *

NAME *

ADDRESS (WHERE YOU WOULD LIKE THE CERTIFICATE TO BE MAILED): *

Single Line Text *

City *

State

Zipcode *

Country *

EMAIL *

PREFERRED PHONE *

COMMENT *

If you are human, leave this field blank.