New Christians Request Baptism

BAPTISM CANDIDATE'S 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?

Pastor Jason Bromley

Pastor Gabriel Asension

Pastor Justyn Wright

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

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

PREFERRED PHONE

COMMENT

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