Good Success Water Baptism Request

Good Success

Online Baptism Application

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Type Of Baptism

ChildAdultBoth
Name

First NameLast Name
Date

MonthDayYear
Date Of Birth

MonthDayYear
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
E-mail
Phone Number

Area CodePhone Number
Type of Baptism

SingleJoint
Spouse Name

First NameLast Name
Spouse Date of Birth

MonthDayYear
Child 1 Name

First NameLast Name
Age
Child 2 Name

First NameLast Name
Age
Child 3 Name

First NameLast Name
Age
Child 4 Name

First NameLast Name
Age
Child 5 Name

First NameLast Name
Age
* I am currently at least 10 years of age, and/or I am a parent or guardian of a child who is currently 10 years of age or older, who understands and has received salvation according to Romans 10:9-10, and desires to be water baptized according to the Word of God. By submiting this form, you release GSCCM, leaderss and anny other associations of GSCCM from any and all liability.

Click this link for the "Child Baptism" instruction sheet.
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