Baptism • Clayton Church

First Name *

Last Name *

Gender

Date of Birth

I am 18 years of age and older

I am under 18 years of age

Tip: If you are under 18 years of age we will require permission from a parent or guardian

Home Address

Email Address

Phone

Life Group Leader/s

Have you confessed Christ as your Lord and Saviour?

If yes when, roughly what date?

and where?

Do you have anyone in mind that you would like to go through the baptism course and be baptised by? If so please provide their name and contact.

We would like to provide you with a special t-shirt on the day of your baptism. Please let us know your size.

What preferred name would you like on your certificate?

Following your baptism, are you interested in becoming a member of this Church?

I would like more information

Yes

If you are under 18 years of age we will require permission from a parent or legal guardian

PARENTAL CONSENT

Parent/Guardian's Full Name *

Relationship to child *

I give permission for my child (named at top of form) to be baptised as per the request made in this form.

DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.

Parent/Guardian's Signature *

Date *

Thank you for filling out this form. If you have concerns about the information that Clayton Church collects and how it is used, please refer to our website http://www.claytonchurch.org.au/policies/