Baptism Registration Form

NOTE:

* Please enter the name of the person being baptized.

* Please provide an email address for future communication in regards to this baptism.

If the registration is for a child, as noted above, the name on the form needs to be the child's name. Additionally, for communication purposes, please enter an email address for a parent or guardian.

Your name *

Email address *

Address *

Full name of baptism candidate as you would like it to appear on your certificate *

If candidate is a minor, list both parent/guardian(s) names

Phone number *

Birthdate *

Date of Salvation *

Briefly describe your salvation story and relationship with Jesus Christ *

Do you have any mobility issues? *

Our baptistry is located on the second floor and there are some stairs leading to the baptistry and stairs in the baptismal pool. (Alternate arrangements can be made if steps are a challenge.)

Yes

Requested Date of Baptism *

Which service do you prefer to be baptized in? *

9:15 am

Are you a Splash Class participant?

Yes

Once we process your registration form, you will receive an email letting you know information on what to bring, when to arrive, & where to go. If you have any questions, feel free to reach out to us at 434-592-5630 or at jennifer.kirk@trbc.org

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