Baptism Registration

Please enter the person being baptized. Adults can enter their own contact email and phone; for students/children, use a parent or guardian contact.

Registrant First Name

Registrant First Name is required.

Registrant Last Name

Registrant Last Name is required.

Contact Email

Email address is not valid

Contact Email is required.

Contact Mobile Phone

Contact Mobile Phone is required.

Registrant Birth Date

Registrant Birth Date is required.

Registrant Address

AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY

Shirt Size

Youth Small Youth Medium Youth Large Adult Small Adult Medium Adult Large Adult XL Adult XXL Adult XXXL

Shirt Size is required.

How you want your name to appear on your certificate?Baptism Certificate Name is required.

Baptism Service

Sun Oct 18 2026 - 11:30 AM

Baptism Service is required.

Tell us about your life before Jesus. How did He come into your life and how has your life changed?

Tell us about your life before Jesus. How did He come into your life and how has your life changed? is required.

Photo

Upload

Photo is required.

What is your favorite Bible verse?Comments is required.