Application for Water Baptism Form

* = Required Information

If you are interested in being baptized, please complete the Application for Baptism below, which provides a way for us to become acquainted with you and your spiritual walk.

Today's Date

First Name *

Middle Name

Last Name *

Name you want on your certificate (if not your legal name)*

Date of birth*

Street Address *

City*

State

Zip Code*

Email *

Primary Phone *

Is this a home or cell phone?

Cell Phone

Home Phone

What church or religious backgrounds have influenced your life—positively, negatively, or both?

Explain how you came to saving faith in Jesus Christ.

Explain the gospel of Jesus Christ. How is a person made right with God?

What Scriptures did God use that were instrumental in your coming to Christ?

How has your life changed since you put your faith in Christ?

Why do you want to be baptized?

In your own words, explain the purpose of baptism