Name of Baptismal Candidate* First Middle Last Date of Birth* Month Day Year Gender* Male Female Name of Parent or Guardian (if under 18 years old) First Last Phone Number*Email Do you have any physical or health conditions that require special accommodations in order for you to participate in the Baptism?* Yes No Please describe your physical or health condition and the special accommodations required. CaptchaBy submitting this Baptism Request Form, you acknowledge release of any photographs and video that may be taken of you during this event by Harvest Life Church or Lyle and Deborah Dukes Ministries to be used for our purpose.
