Baptism Application Entry

First Name

Nick Name

Last Name

Gender

Male Female

Minor

Address

Campus

In which service would you like to be baptized?

Who are 1 or 2 people at BR who have impacted your faith journey? (Please include an email address or phone number if possible.)

Who would you like to baptize you?

Mobile Phone

Home Phone

Work Phone

Date of Birth

/ /

Age Group

T-Shirt Size

I have watched or will watch the Baptism Video