Title                        

First Name              

Last Name               

 

Date of Birth:    JanFebMarAprMayJunJulAugSepOctNovDec   1920 

 

Address                   

 

 

City        Zip   

 

Telephone                 

Email                       

 

 

 

Please describe your spiritual backround(raised in church, other religious organizations, no church or religious background, etc)

 

 

Describe your experience when you accepted Christ, what led you in accepting Him.

 

 

How has your life been impacted by this decision?

 

 

I/we , the parents(s) of the above named, give our consent for our child to be baptised in water by immersion.