1.  Full legal name __________________________________

2.  Address __________________________________________

3.  Phone ( ) ________________

4.  Date of birth _________________

5.  Have you been able to attend our Baptism Class or read through our church's paper on the
meaning of baptism?   

    yes ___ no ___  
6.  Why would you like to be baptized?

7.  How would you describe how things are between you and God right now?

8.  If you died tonight, are you certain you would go to heaven?   

    yes ____ no ____ not sure ____  

9.  If God asked what you are relying on to get yourself into heaven, what would you say?

10.  Was there ever a time in your life when you chose to turn from your sin and accepted
Jesus as your Lord and Savior for the rest of your life?

    yes ____ no ____ not sure ____
    If yes, please describe the circumstances surrounding your decision to accept Jesus.        
Baptism Application
Your Organization Name Here