Next Steps Registration

Name*
First Last
Email*
Phone*
Address*
Street Address City State ZIP Code
Birthday*
Gender*
Are you 18 years or older?*
- Yes
- No
If under 18, please give your parent(s) name(s)
Marital Status*
Spouse's Name

If your spouse would like to attend Next Steps along with you, they MUST fill out a separate application.
Do you need childcare (11 and under)?*
- Yes
- No
Children Information:
Child's Name Birthday Gender Allergies
Have you trusted Jesus Christ for your salvation?
- Yes
- No
- I am not sure
- I would like to talk to someone to be assured
If Yes, When?
Have you been baptized after you trusted Jesus Christ?
- Yes
- No
- I want to be baptized
If Yes, When?
I have questions regarding baptism and/or salvation. Please call me at
A new habit I would like to begin is:
- Connecting with others in Groups
- Serving the world through the Dream Team
CAPTCHA

Child's Name	Birthday	Gender	Allergies