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Water Baptism

1. Name & Surname: *

2. Age Group: *

0-12 years

13-18 years

19-25 years

26-30 years

31-40 years

41-50 years

51-60 years

61+ years

3. Cellphone Number: *

4. Which area do you stay? *

5. Are you a Member of CRC? *

Yes

No

No, but I would like to be

6. Are you in a Homecell? *

Yes

No

No, but I would like to join one

7. What is your Homecell Leaders Name?

8. Which Zone are you in? *

Working Adults Zone

Family Zone

Youth Zone

Student Zone

Women’s Zone

I don’t know

Not in a zone

9. Have you been baptised before? *

No

Yes, but I would like to get baptised again