BAPTISM COUNSELING FORM
Please fill out this form and click submit.
Name
*
Email
*
This address will receive a confirmation email
Phone
*
Address
*
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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
Age group
*
Please select all that apply.
10 and under
11yrs-18yrs
19yrs and older
This counseling is for
*
Please select one option.
First Full Immersion
Rededication
Previous baptism?
Please select one option.
Infant- immersion
Infant- sprinkling
youth/adult- sprinkling
youth/adult- immersion
n/a
Counseled by
*
Date counseled:
*
Candidate for Baptism
*
Please select all that apply.
Yes
No
Scheduled for Baptism on:
*
Which service?
*
Please select all that apply.
8:30am
10:00am
11:30am
Baptized by:
*
Counseling notes or explanation if not ready:
Date accepted Christ
*
Name announced as:
*
Name as desired on Certificate:
*
T-shirt size:
*
Please select one option.
YS
YM
YL
YXL
AS
AM
AL
AXL
A2XL
A3XL
Submit
Description
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