Shepherd of the Hills Baptism Intake Form
Please fill out completely. The information provided will be printed on the child's Baptism Certificate
Baptism Request Date
-
Month
-
Day
Year
Date
Child's Full Name
*
First Name
Middle Name
Last Name
Child's Date of Birth
-
Month
-
Day
Year
Date
Place of Birth
Example: Duluth, MN
Father's Name
*
First Name
Last Name
Mother's Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact Number
*
-
Area Code
Phone Number
Contact Email
*
example@example.com
Witness / Godparent 1 Name
First Name
Last Name
Witness / Godparent 2 Name
First Name
Last Name
Parent Signature
Please sign before submitting if you are printing out the form to give to Pastor Denney
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