Baptismal Application Form

Applicant information

Full name * Age group (Please select one): * Email address *

Phone number

Enter a Canada phone number, e.g. 000-000-0000.

Residential address (street, city, postal code) *

Have you accepted Jesus as your Lord and Personal Savior? * Do you consent to baptism by immersion? * Tell us your salvation story

* Signature requirement: adults should print their own name. For applicants under 18, a parent or guardian should print their name instead.

Signature (print name) Parent signature (print name) for minors under 18

RCCG DSM Baptismal Application Form