Baptism Registration Name* First Last Email* Preferred Phone Number*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Age*Under 1818+Please Select Your Age Group*9-12th Grade6-8th GradeK-5th GradeWhy do you want to be baptized?*Tell us a little bit about your life before accepting Christ and surrendering your life to Him:*Tell us how and when you realized that Jesus Christ gave His life for you and died for your sins.*Tell us about how He has changed your life since then:*Please indicate your readiness.*I am ready to schedule my baptism.I need to speak with somone before I am ready to schedule my baptism. Please contact me.Video Release*Please read the Video Release, then check the box below to give Journey permission to show your video. I have read and agree to the Video Release. Minor Video Release*Please read the Video Release, then check the box below to give Journey permission to show your child's video. As parent or guardian of the registrant above, I have read and agree to the Video Release. Once you press "Submit" you will receive an email that explains the next steps in the baptism process.NameThis field is for validation purposes and should be left unchanged.