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Baptism Ceremony

Contact Information
Your Name*

Address*

City*

State*

Zip*

Phone 1*

Phone 2*

Email*

Additional Information
Have you been born again?*

Yes | No

Are you a member of this church?*

Yes | No

Age*

Current weight?

Do you have any special considerations that we need to be aware of?

Do you have any physical handicaps, illness or other limitations that need special attention?