Baptism Form

Valley Kingdom Ministries International

Date to be Baptized(Required)

Name(Required)

Date of Birth(Required)

Address(Required)

Suite/Apt

City(Required)

State(Required)

Zip(Required)

Home Phone

Mobile Phone(Required)

Email(Required)

T-Shirt Size(Required)

Guardian information if you are under 18 years old

Guardian's Name

Relationship

Guardian's Address

Guardian's Suite/Apt

Guardian's City

Guardian's State

Guardian's Zip

Guardian's Phone

Guardian's Cell Phone

Guardian's Email

T-Shirt Size