I want to be Baptized
Please fill out this form and click submit.
Name
*
Email
Phone
*
Address
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Birthday
*
Are you filling this form out on behalf of your child or student? *
*
Please select one option.
Yes
No
Select Option
Yes
No
What is your life stage?
*
Please select one option.
Child (k-5th grade)
Youth (6th - 12th grade)
Adult
Select Option
Child (k-5th grade)
Youth (6th - 12th grade)
Adult
Are you a covenant member of Ember Church
*
Please select one option.
Yes
No
Select Option
Yes
No
Are you in a Connect Group
*
Please select one option.
Yes
No
Select Option
Yes
No
Have you been Baptized before?
*
Please select one option.
Yes
No
Select Option
Yes
No
What is your t-shirt size
*
Who would you like to baptize you? It is our policy at Ember Church that any baptized believer can baptize others.
We'll ask everyone who is baptized to share a bit of your story with everyone in attendance as a way to encourage and inspire them with your story of faith. Please complete these three questions below:
On a scale of 1-10 (10 being certain, 1 being not so sure) if you were to die tonight how certain are you that you would go to Heaven
*
If God was to ask
*
Write 3-4 sentences on what God has done in your life and why you are getting baptized…
*
Submit
Description
Please fill out this form and click submit.
×
Please Fix the Following