Please complete the following information, which will be used to enable us to process your baptism application and issue a certificate.

Where would you like to get baptised? *
Date of Baptism *
First Name *
Last Name *
Date of Birth
Year Level
Postal Address
Day-time Contact Number *
Other Contact Number
Email Address
Parent/Guardian's Email Address *
How long have you been a Christian (ie, having accepted Jesus Christ as your Saviour)?
Have you ever been baptised by immersion before?
Do you attend CityLife Church?
Where do you regularly attend CityLife Church?
Are you a member of a Life Group?
Would you like to nominate a Christian family/friend to baptise you?
In your own words, please state why you desire to be baptised by immersion:

Parental Consent
Upon submission of this form, an email will be sent to your parent or guardian, as we require them to discuss and consent your water baptism by immersion.

By submitting this form I hereby consent and agree for me and/or my child(ren) to be filmed by the CityLife Church media team and for my and/or my child(ren)'s image and likeness to be shown in video promotions on the screens at CityLife Church and the CityLife Church website. I understand I will receive no compensation for this filming and the footage may be used in perpetuity.

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We recognise the sovereignty and Lordship of the one true God, revealed through His Son the Lord Jesus Christ, and acknowledge the traditional custodians of the land where we work and live, the Kulin Nation, and pay our respects to Elders past and present.