Embed

<form action="https://formsubmit.co/YOUR_EMAIL_ADDRESS" method="POST">

  
  <input type="hidden" name="_captcha" value="false">

  <label>Name of the Person Being Baptized</label>
  <input type="text" name="Name of Person Being Baptized" required>

  <label>Age (if applicable)</label>
  <input type="text" name="Age">

  <label>Your Name & Relationship</label>
  <input type="text" name="Your Name and Relationship" required>

  <label>Best Way to Reach You</label>
  <select name="Preferred Contact">
    <option>Email</option>
    <option>Phone</option>
    <option>Text</option>
  </select>

  <label>Preferred Date (or general timeframe)</label>
  <input type="text" name="Preferred Date">

  <label>Location (home, church, outdoors, etc.)</label>
  <input type="text" name="Location">

  <label>Tell me a little about your story</label>
  <textarea name="Your Story" rows="4"></textarea>

  <label>What draws you to baptism right now?</label>
  <textarea name="Reason for Baptism" rows="4"></textarea>

  <label>Would you like to meet first?</label>
  <select name="Meet First">
    <option>Yes, absolutely</option>
    <option>Yes, phone/video</option>
    <option>Not sure yet</option>
  </select>

  <label>Anything else you'd like me to know?</label>
  <textarea name="Additional Notes" rows="4"></textarea>

  <button type="submit">Send Inquiry</button>
</form>

Square one

Why come here instead of a therapist, pastor, or counselor?
I’m not here to diagnose you, fix you, or recruit you. I’m here to walk beside you. What I offer is a slow, porch-side kind of presence—especially for the grieving, the spiritually bruised, and the ones who love Jesus but feel lost in the noise of church culture.