Shepherd of the Hills Baptism Intake Form

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

MonthDayYear
Date
Child's Full Name*

First NameMiddle NameLast Name
Child's Date of Birth

MonthDayYear
Date
Place of Birth
Example: Duluth, MN
Father's Name*

First NameLast Name
Mother's Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Number*

Area CodePhone Number
Contact Email*
example@example.com
Witness / Godparent 1 Name

First NameLast Name
Witness / Godparent 2 Name

First NameLast Name
Parent Signature

Please sign before submitting if you are printing out the form to give to Pastor Denney
Should be Empty: