Register to be Water Baptized

First Name

Last Name

Please fill out the name portion the way you would like it to appear on your baptism certificate!

Contact Number

Email

What age group do you fall in?

If participant is younger than 18 years of age, please provide Parent/Guardian information

Parent/Guardian First Name

Parent/Guardian Last Name

Guardian Number

We have a gift for you! What size t-shirt do you wear?

Which 2025 Baptism date works best for you?

How many will be joining us for breakfast?

Have you surrendered your heart to Christ?

Please share your salvation testimony below: