Baptismal Candidate Form

First Name

Last Name

M.I.:

Parent’s Name (if under 18):

Gender

Male

Female

Age;

Are you a member of the Embassy Church?

Yes

No

Have you Completed New Members Orientation:

Yes

No

Do you have a medical condition that could potentially harm yourself and/or others:

Yes

No

If yes, please explain briefly:

Are you pregnant:

Yes

No

Address

Street Address

City

State / Province / Region

Zip Code

Country

Home Phone

Cell Phone

Email Address