Pathway Community Church

Name * First Last
Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Primary Phone Number * ### - ### - ####
Additional Phone Number ### - ### - ####
Email *
Birthday * MM / DD / YYYY
For your Baptism T-shirt: *
T-Shirt Size *
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? *
What has most influenced your decision to be baptized? *
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? *
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
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