Baptism Request

Buried with Him in baptism, wherein also ye are risen with Him through the faith of the operation of God, who hath raised Him from the dead. – Colossians 2:12 (KJV).

Information of Person To Be Baptized

Name:

Gender:

Male Female

Date of Birth:

City/State of Birth:

Address:

Phone:

Email:

This address will receive a confirmation email

Please check the ones that apply:

I’m a member of Bibleway and I want to be baptized I’m a member of Bibleway and I want to have my child baptized (Fill out the information below please.) I’m not a member of Bibleway but I want to be baptized

If you’re a member at another church, what is the name of your church?

Information of Parents if your Child is being Baptized

Father’s Full Name:

Mother’s Full Name:

Are you married? Yes No

Address:

Phone:

Email:

Child’s Full Name:

Child’s Date of Birth:

City/State of Birth:

If your child is under 18 years of age, parent must sign consent and liability release form upon baptism.

Description

Please fill out this form and click submit.

Baptism Request

Description

Please Fix the Following