BAPTISM INFO REQUEST

If you or your child has accepted Christ as their Savior and is interested in baptism, please fill out the form below. Your campus Baptism Director will contact you to schedule a baptism interview for you or your child. This interview is an opportunity for the staff and volunteer leaders of Century 21 Church to talk with you or your child about baptism, and help you determine if you or they are ready to be baptized.

Parent's Name

First Name*

Email address*

Last Name*

Phone Number*

Child's Name

First Name*

Child's Grade *

Campus* *

Last Name*

Child's Age *