UBATIZO

Applicant Full Name *

First

Last

Applicant Requested or

Date of Birth *

Place of Birth (City and Country) *

Current Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Applicant Phone Number

Applicant Email Address

Requested Baptism Date

Baptism Service Location (Church)

Type of Baptism Requested *

Infant Baptism
Child Baptism
Youth Baptism
Adult Baptism

Brief Testimony or Reason for Baptism Application

Parent or Legal Guardian Name(s)

Parent or Legal Guardian Phone

Parent or Legal Guardian Email

Are you currently a member of this church?

Yes, I am a member
No, but I regularly attend
No, I am visiting
Other

Additional Notes or Special Requests for Baptism

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