Baptism Form Your Name* Address* City* State* Zip* Phone 1* MobileHomeWork Phone 2* MobileHomeWork Email* Additional Information Have you been born again?* Yes | No Are you a member of this church?* Yes | No Age* 5-1213-1920-2930-3940-49Over 50 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?