Adult Baptism Registration Form

2025-2026

Your name *

Email address *

Phone Number

Name:

Birthdate *

Please choose the Service you wish for your Baptism *

May 16/17 (Register by May 1st)

6:00 PM-May 16, 2026 (2 Spots)

9:15 AM-May 17, 2026 (2 Spots)

11:00 AM- May 17, 2026 (2 Spots)

Choice #1-Pastor/Ministry Leader or Small Group Leader *

If choosing Small Group Leader/Other, they must be current members of Heartland.

Choice #2- Pastor/Ministry Leader or Small Group Leader *

In the event your first choice is unavailable, please choose a second.

Please begin to consider who you would want to have come do a word of encouragement for you before your Baptism (1 min long only).

If you know who you want this to be already, put their names below. (Can be the same person or different person who prays) It is your responsibility to contact this person yourself.

Please begin to consider who you would want to have come pray for you before your baptism.

If you know who you want this to be already, put their names below. (Can be the same person or different person who prays) It is your responsibility to contact this person yourself.

Are you interested in having your testimony pre-recorded? *

Yes

No- I will read it live.

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