Water Baptism Form
Please complete the following information, which will be used to enable us to process your baptism application and issue a certificate.
Last Name
*
First Name
*
Date of Birth
*
Phone Number.
Gender
*
Male
Female
Marital Status
*
Single
Married
Other
Street Address
*
City
*
State
*
Zip
*
Have you been born again? (ie, having accepted Jesus Christ as your Saviour)?
*
Yes
No
Have you ever been baptized by immersion before?
*
Yes
No
Do you attend Bethel Family Worship Center?
*
Yes
No
In your own words, please state why you desire to be baptized by immersion:
Your Email Address
*
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