Name *

First Name

Last Name

Phone *

(###)

###

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Requested Baptism Date

Baptism's are performed after 9:00 am Sunday Services

MM

DD

YYYY

Have you watched the Baptism video?

https://youtu.be/PdgTGmVITug

Yes

No

Have you had a baptism Bible study from a HOP staff member?

Yes

No

I would like to

Are you 18 years old or younger? *

If so, parental consent is required.

Yes

No