Baptism Form
PLEASE COMPLETE THE FOLLOWING INFORMATION; WHICH WILL BE USED TO ENABLE US TO PROCESS YOUR BAPTISM FORM AND ISSUE A CERTIFICATE.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Gender
*
Please select one option.
Male
Female
Date of Birth
*
DO YOU ATTEND REVENANT WORSHIP CENTER?
*
Please select one option.
YES
NO
HAVE YOU BEEN BAPTIZED BY IMMERSION BEFORE?
*
Please select one option.
YES
NO
HAVE YOU BEEN BORN AGAIN?
*
Please select one option.
YES
NO
HAVE YOU READ THROUGH AND UNDERSTAND THE BAPTISM TEACHING ON OUR WEBSITE?
*
Please select one option.
YES
NO
IN YOUR OWN WORDS, PLEASE STATE WHY YOU DESIRE TO BE BAPTIZED IN WATER:
*
Submit
Description
PLEASE COMPLETE THE FOLLOWING INFORMATION; WHICH WILL BE USED TO ENABLE US TO PROCESS YOUR BAPTISM FORM AND ISSUE A CERTIFICATE.
×
Please Fix the Following