Name *

First

Middle

Last

Email *

Phone *

Date

Address

Address Line 1

Address Line 2

City

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Zip Code

Are You Born Again? *

• Yes
• No

When did you become a Born Again Christian?

Are you a Royalhouse Chapel Member? *YesNo

If Yes, what is your Tithe Card Number?

If No, have you enrolled in The Foundation School?

• Yes
• No

If Yes, what class are you?

If No, when do you intend to enroll?

In a few words, please explain why you want to be Baptised

Submit