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Application Entry

Children's Baptism Application

Please Note: Children Grade 1 or older can make a request to be baptized as a child at Centre Street Church with Parents Permission

First Name

First Name is required.

Last Name

Last Name is required.

Birthdate

/ / Birthdate cannot be a future date.

Gender

Male Female

Gender is required.

Address

Grade

Grade is required.

Parent/Guardian Name(s)

Parent/Guardian Name(s) is required.

Which campus do you attend?

Which campus do you attend? is required.

Name you would like on your certificate

Name you would like on your certificate is required.

Email

Email address is not valid

Email is required.

Home Phone

Home Phone Availability

Morning Afternoon Evening

Cell Phone

Cell Phone Availability

Morning Afternoon Evening

What is the best way to contact you?

Home Phone Cell Phone Email

What is the best way to contact you? is required.