Request for Believer's Baptism

First Name

Last Name

Phone

Email Address

Small Group (if attending)

Discipled By (if involved in discipleship)

1) Have you, by faith, accepted Jesus Christ as your personal Lord and Savior? 1) Have you, by faith, accepted Jesus Christ as your personal Lord and Savior? Yes No

If yes, date or year of salvation:

2) When would you like to be baptized?

3) Any other special requests?

Please write out your personal testimony as you would like it to be read on the day you are baptized. Please include all sections listed: A) What was your life like before you met Christ? B) What happened that made you realize you were a sinner in need of a Savior? C) What specifically did you do to receive Jesus Christ? D) What is your life like now that you have surrendered it to Jesus?