Baptism Form

"*" indicates required fields

Candidate Name*

First Last

Date of Birth*

Gender

Female

Male

Phone*

Address

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

Father's Name

First Middle Last

Mother's Name

First Middle Last

Member (Partner) or Visitor*

Member (Partner)

Visitor

House of Freedom

3507 Moss Street
Lafayette, LA 70507

www.thehouseoffreedom.com
[email protected]

Wednesday Bible Study 7:00 PM
Sunday Worship 10:00 AM