BAPTISM REQUEST

Form Entry

Peter replied, "Repent and be baptized, every one of you, in the name of Jesus Christ for the forgiveness of your sins. And you will receive the gift of the Holy Spirit." –Acts 2:38 (NIV) ... Please complete all of the fields below for the individual being baptized.

First Name

Last Name

Mobile Phone

Birthdate

/ /

Gender

Male Female

NE! Kids Baptism Booklets must be completed prior to baptism for children in grades 2-4 and can be picked up at Connect Central. If person getting baptized is younger than 5th grade, did he/she complete the booklet?

No Yes

Jesus died to pay the penalty for your sins. Have you put your faith in Jesus as your Savior?

No Yes

Baptism and Repentance go together. Are you ready to turn from your old life of sin and surrender fully to Jesus as the Lord of your life?

No Yes

When would you like to be baptized?

Select your Baptism T-Shirt Size.