Water Baptism Form

Water Baptism
Which campus or church do you attend?

Lafayette Campus Throggs Neck Campus Online
Full Name

First Name Last Name
Gender

Male Female
Birth Date

Month Day Year
Marital Status

Married Single Widowed Divorced
Address

Street Address Apt. #
City, State

City State / Province
Zip Code
Mobile Phone

Area Code Phone Number
E-mail
Have you accepted Jesus Christ as your Personal Savior?

Yes No
How long have you been attending LTF?
Have you been baptized?

Yes No
If yes, where?
Baptism Date

Month Day Year
Was Certificate Issued?

Yes No
Should be Empty: