1700 Napa Valley Drive - Little Rock, AR, 72212
Office (501) 225-9231
Ministries
Mission and Outreach
Asbury Christian Child Development Center
Children’s Ministry
Student Ministries
Adult Ministry
Music Ministries
Member Resources
Donate
Ministry Teams
Forms
Directory
Events / Media
Sermon Audio/Visual
Weekly Bulletins
Calendar
Member Resources
Donate
Ministry Teams
Administrative and Office Ministries
Adult Discipleship Ministries
Children’s Ministry Team
Congregational Care Ministries
Hospitality Ministries
Missions and Outreach Ministries
Student and Young Adult Ministries
Forms
A Covenant For Ministry
New Membership Information
Ministry Reference Guide
Baptism Information Form
Directory
Archives
Search our Website
Search for:
Upcoming Events
Forms
Baptism Information Form
Baptism Information
Please fill out this form as completely as possible.
First name
*
Middle name
Last name
*
Birthday
*
mm/dd/yyyy
City & State of Birth
*
Mother's First Name
*
Mother's Middle Name
Mother's Last Name
*
Father's First Name
*
Father's Middle Name
Father's Last Name
*
List any siblings, and their ages (ex. John Doe, age 4)
List any other family attending Asbury, and their relationship (ex. Jane Doe, Grandmother)
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Greece
Greenland
Grenada
Guam
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Puerto Rico
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Sudan, South
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Yemen
Zambia
Zimbabwe
Country
Phone
Email
Date of Baptism
*
mm/dd/yyyy
Officiating Pastor
*
Rev. Mary Hilliard
Rev. Chase Green
Rev. David Moore
Rev. Tom Weir
Service Time
*
8:30 am Divine
10:45 am Divine
10:45 am Celebration