Baptism Request

"Those who accepted his message were baptized" - Acts 2:41

Please fill out this form to be scheduled for baptism.

Your name *

Last name

Email address *

Phone number *

Phone type

MobileHomeWorkOther

Address *

HomeWorkOther

Country

Country

Street address

Apt/unit/box (optional)

City

State

Postal code

Birthdate *

Gender *

Select…MaleFemale

Are you able to enter and exit the baptism pool unassisted? *

Select…YesNo

T-Shirt Size *

Select…SMLXL1XL2XL3XL

Have you accepted Jesus Christ as your personal Lord and Savior:

Yes

No

I understand what believer's baptism is and want to be baptized as a public declaration of my allegiance to Jesus:

Yes

No

Submit

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