CITYHEART BAPTISM
Baptism Candidate Info
Is this for a child 1st grade - 17 years old?
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Yes
No
First Name
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Gender
Male
Female
Marital Status
Single
Engaged
Married
Partner
Widowed
Divorced
Separated
Have you accepted Jesus as Your Lord and Savior?
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Yes
No
Salvation Date
Last Name
*
Date of Birth
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School Grade
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-- None --
Nursery (Babies 0-11mths)
1s (12-23mths)
Toddler (2+3s)
Preschool (4+5yrs)
K
1
2
3
4
5
6
7
8
9
10
11
12
Parent's First Name
*
Parent's Last Name
*
Let us know the best way to connect.
Email Address
*
Mobile Number
*
I'm Making the Decision to...
This is one of the most important things you can do for your faith!
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