NEXT GEN Baptism Form

NEXT GEN Baptism Form

Please fill out one form per family at the SAME ADDRESS baptized on the SAME DATE.
Date of Baptism*

MonthDayYear
Date
Baptism Campus*

Mount Pleasant Christian ChurchIMPACT Old SouthsideIMPACT CenterIMPACT FairfaxIMPACT Bethany
Individual #1 Name*

First NameLast Name
Individual #1 Adult over 18 or Minor

Adult over 18Minor
Individual #1 Date of Birth*

YearMonthDay
Date
Individual #1 Grade in 2022-2023 school year
Parent/Guardian Name

First NameLast Name
Email
example@example.com
Parent/Guardian Email
Phone Number
Please enter a valid phone number.
Parent/Guardian Phone Number
Please enter a valid phone number.
Add additional individual (same baptism date/same address)

YesNo
Individual #2 Name

First NameLast Name
Individual #2 Adult over 18 or Minor

Adult over 18Minor
Individual #2 Date of Birth

YearMonthDay
Date
Individual #2 Grade in 2022-2023 school year
Individual #2 Marital Status

SingleDivorcedMarriedWidowedEngagedCohabiting
Individual #2 Email
example@example.com
Individual #2 Phone Number
Please enter a valid phone number.
Add additional individual (same baptism date/same address)

YesNo
Individual #3 Name

First NameLast Name
Individual #3 Adult over 18 or Minor

Adult over 18Minor
Individual #3 Date of Birth

YearMonthDay
Date
Individual #3 Grade in 2022-2023 school year
Individual #3 Marital Status

SingleDivorcedMarriedWidowedEngagedCohabiting
Individual #3 Email
example@example.com
Individual #3 Phone Number
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Should be Empty: