Pathway Community Church
Baptism Registration
Are you ready to go public with your faith through baptism? We are so excited to take this transformational step with you. To begin this process, you simply need to complete this form.
PLEASE NOTE: You must be 8 years old to be considered for baptism at PCC. All youth age 8-17 will be required to meet with a member of the PCC Staff prior to being approved for baptism.
Name
*
First
Last
Address
*
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
United States
United Kingdom
Australia
Canada
France
New Zealand
India
Brazil
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Afghanistan
Åland Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Democratic Republic of the Congo
Republic of the Congo
Cook Islands
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Curacao
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Primary Phone Number
*
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Additional Phone Number
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Email
*
Birthday
*
MM
/
DD
/
YYYY
For your Baptism T-shirt:
*
Youth Size
Adult Size
T-Shirt Size
*
Small
Medium
Large
XL
XXL
XXXL
Other
Have you made a personal decision to receive Jesus as your Savior?
*
Yes I have
No I have not
How long ago did you make this decision?
*
Less than 12 months
1-2 years
3-5 years
More than 5 years
What has most influenced your decision to be baptized?
*
Bible Study
Church Announcement
Family or Friends
Church Membership
Pastoral Teaching
Serving Event
Small Group
Weekend Service
Please tell us a little bit about your journey. Include a sentence or two about your life before Christ, what brought you to accept Him as your Savior, and a statement about why you want to be baptized. NOTE: This is the testimony that we will use during your baptism service. Please be as concise as possible. Due to time constraints, if your story is a long one, we may need to work with you to shorten your story to fit our service format.
*
Must be at least
140
characters.
Currently Used:
0
characters.
Which baptism service would you prefer?
*
Saturday, 5pm
Sunday, 9am
Sunday, 11am
Outdoor [August only]
Do you have any special needs or disabilities?
*
Yes
No
If yes, please explain
Are you being baptized with another friend or family member?
*
Yes
No
If yes, whom?
Will there be anyone in the baptism pool with you as you are baptized? (family member, mentor, etc)
*
Yes
No
If yes, whom?
Would you be willing to do a short video of your testimony to be shown during the weekend service, if asked?
*
Yes
No
Do Not Fill This Out