Student Ministry Baptism Form

Combined Nights | Please fill out this form and click submit.

Name

*

Parent Email

*

This address will receive a confirmation email

Parent Cell

*

Student Cell

*

Grade

*

Please select one option.

6th 7th 8th 9th 10th 11th 12th

Date of Birth

*

Parent's Name ( if under 18)

*

Have you completed Baptism Class

*

Please select one option.

Yes No

What is most true:

*

Please select one option.

I recently received Jesus as my Savior I came to Christ earlier but was never baptized I want to be rebaptized

I became a follower of Christ when (or because of):

*

Since becoming a Christian my life has become...

*

Any further comments?

*

Description

Combined Nights

Please fill out this form and click submit.

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