Interest in Baptism

1
Who's interested in baptism?* This field is required.Check one or both options below. If both, we'll start with your information then your children's information.
I'd like to be baptized
My child would like to be baptized
2
Your Name* This field is required.
First Name
Last Name
3
Email* This field is required.
example@example.com
4
Phone Number* This field is required.
Please enter a valid phone number.
5
Your Birthday* This field is required.
Date
Month
Day
Year
6
Is this your first time being baptized?
YESNO
7
Tell us about your previous baptismHow old were you? What were the circumstances?
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Ok
Ok
8
Why do you want to get baptized again?
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Ok
Ok
9
Why do you believe now is the right time for you to be baptized?
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Ok
Ok
10
When did you first begin following Jesus?
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Ok
Ok
11
Are you unsure if baptism is right for you? If so, would you like a pastor to reach out before the class?
YESNO
12
What is the best way to contact you?Please provide phone number or email
13
Child's Name
First Name
Last Name
14
Child's Date of Birth
Date
Month
Day
Year
15
When did your child begin following Jesus?
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Ok
Ok
16
Why do you believe now is the right time for your child to be baptized?
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Ok
Ok
Should be Empty: