Full Name

Name (as you would like it to appear on the Baptism certificate)

Address (be sure to include city and zip code)

Birthdate

Email

Phone Number

T-shirt Size

Have you accepted Jesus as your personal Savior?
Yes
No

Have you been baptized before?
Yes
No

At which service would you like to be baptized?
9am
11am
No preference

How long have you been attending Rolling Hills Covenant Church?

Is there a pastor or elder at RHCC who has had an impact on your life that you prefer to baptize you?

Why do you want to be baptized?

Briefly write out how you came to personal faith:

Who is Jesus Christ?

If you were to die today, where would you go and why?

How are you currently involved at RHCC? (Life Groups, serving, attending?)