Full Name

Date of birth

Phone *

Email *

Marital Status -

Single

Married

Divorced

Widowed

Sex

Have you been Baptized Before?

Yes

Do you confess Jesus Christ as Lord and believe God raised Him from the dead?

Yes

I understand that baptism is an outward expression of my inward faith in Jesus Christ — symbolizing that I have died to my old life and been raised to new life in Him.

Yes, I understand.

Current Church or Ministry. If N/A leave Blank.

Check anything you’ve participated in before knowing Jesus. If none apply, leave blank.

Witchcraft

New Age Practices and Spirituality

Divination/Tarot Card readings

Ouji boards/Spirit channeling

Astral Projection or Lucid Dreaming Practice

Free Masonry or Secret Societies

Blood Rituals/ Sex Rituals

Curses/Vows/Oaths

If You selected Any. Briefly Describe.

Areas where you want breakthrough:

anger

substance abuse

sexual sin or pornography

anxiety or fear

unforgiveness

depression or heaviness

occult objects or media

night terrors or oppression

other

none

If You selected Any. Please Describe.

Prior to and leading up to the day of your baptism, we encourage you to reflect on your life and write down things you need freedom from.

On the day of, we will join with you in private to pray over you and with you. Breaking off old ties of your former self

We’re excited to walk this journey with you. In this moment, you will receive power from the Holy Spirit — a transformation that will mark your life forever.