The Potter's House Church

Baptism Candidate Information

Please only submit one name per entry.

Candidate's Name(Required)

First Last

Age(Required)

Baptism candidates must be 5 years of age or older.

Candidate's Phone Number(Required)

Candidate's Email(Required)

Candidate's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Are you a member of The Potter's House?(Required)

2025 Baptism Calendar. Select your Baptism date below(Required)

T-Shirt Size:

If you require special accommodations, please list them below.

Is this candidate 18 years old or younger?(Required)

Name of Parent (s)/Legal Guardian(Required)

First Last

Email of Parent (s)/Legal Guardian(Required)

Enter Email Confirm Email

Primary Contact Number for Parent (s)/Legal Guardian(Required)

Secondary Contact Number for Parent (s)/Legal Guardian

What school does this child attend?(Required)

Please select your preferred youth ministry for this baptism.

Children 12- and 13-year-olds have the option to be baptized by our Firehouse (13yr - 17yr) or Destiny World (12yr and under) Youth Ministries.

Consent(Required)

I agree

I consent to my child’s participation in baptism at The Potter’s House Church of Dallas Inc.

Signature of Parent (s)/Legal Guardian(Required)

Name

This field is for validation purposes and should be left unchanged.