Baptism Sign-Up - Passion Community Church

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Baptism Sign-up

Name*
First Last
Phone*
Email*
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
I am interested in (please check all that apply):*
- Being baptized. I have already accepted Jesus Christ as my Lord and Savior.
- Learning more about becoming a Christ follower and/or baptism.
- Speaking with someone about baptism.
What size t-shirt do you wear? (Those being baptized will receive a t-shirt in celebration of their decision.)
Are you an Adult, Student or Child?*
- Adult (age 18+)
- Student (grades 6-12)
- Child (age 8+)
Which campus do you attend?*
- Aylett
- Farmville
- Midlothian
- Online
- Powhatan
- Riverside
Who would you like to baptize you?*
Please indicate your baptism preference:*
- I would like to be baptized individually.
- I would like to be baptized along with someone else.
- We would like to be baptized as a family unit.
Please list the names of anyone you would like to be baptized with:
First Last
Name
First Last
Please list any additional details, questions or comments:

Δ

4480 Anderson Hwy,
Powhatan, VA 23139

804.598.1174
info@pccwired.net

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