Baptism Submission Form

Baptism Submission Form
Membership Status*
Baptism Candidate (Full Name)*

First NameLast Name
Date of Birth*

MonthDayYear
Baptism Candidate T-Shirt Size*
Parent's Name (if candidate is under 18yrs old)

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Do you and/or your minor child(ren) have a medical condition, sensory issue, disability, or accessibility need which may require special accommodations for a safe and positive baptism experience? The Brook Baptism Team will maintain confidentiality and respect your individual needs.*

YesNo
If you answered "Yes" above, please explain the condition and what special accommodations may be needed for you or your family member being baptized. Again, The Brook Baptism Team will maintain strict confidentiality and respect your individual needs.
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