Your Name* First Last Your Email Address* Email Address Confirm Email Address This is the email address of the person filling in this formWho is being baptized?*SelfMy childIs this expression of interest for you or your child?Child's Name* First Last Child's Age*How long have you been a Christian*Less than 12 months1-2 years2-5 yearsover 5 yearsHow long has your child been a Christian*Less than 12 months1-2 years2-5 yearsover 5 yearsTell us about how you became a Christian*Tell us about how your child became a Christian*Commitment to Christ and to His Church are vital prerequisites to baptismI am committed to Southland Church as my spiritual home* I agreeSouthland Church uses the information on this form to allow us to reply to your query. Please read our Privacy Policy and Terms & Conditions of use.I understand and accept Southland Church's Privacy Policy and Terms & Conditions* I agreePhoneThis field is for validation purposes and should be left unchanged.