Baptism Form • Revenant Worship Center

PLEASE COMPLETE THE FOLLOWING INFORMATION; WHICH WILL BE USED TO ENABLE US TO PROCESS YOUR BAPTISM APPLICATION AND ISSUE A CERTIFICATE.

First Name

Last Name

Mailing Address

Mailing City

Mailing State

Mailing Zip Code

Email Address

Phone Number

Date of Birth

Gender

DO YOU ATTEND REVENANT WORSHIP CENTER?

YES

HAVE YOU BEEN BORN AGAIN

YES

HAVE YOU BEEN BAPTIZED BY IMMERSION BEFORE?

YES

IN YOUR OWN WORDS, PLEASE STATE WHY YOU DESIRE TO BE BAPTIZED IN WATER: