Baptism Information Form
St. Philip the Deacon Lutheran Church
Is this Baptism request for a child or an adult?
*
Child
Adult
Select a date for the baptism. If you have previously agreed a date that is not listed here, you can enter that date at the bottom of this page. For more than one child sharing the same date, use that field below when you complete the form for each additional child.
If you have agreed with the baptism coordinator to a date / time for your baptism that was not offered in the above list, please enter it here:
Date / Time Agreed
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Next
Child's Name
*
First Name
Middle Name
Last Name
Child's Gender
*
Male
Female
Please list any siblings:
Father's Full Name
First Name
Middle Name
Last Name
Mother's Full Name
*
First Name
Middle Name
Last Name (Please include mother's maiden name in parenthesis)
Adult's Name
*
First Name
Middle Name
Last Name
Gender
*
Male
Female
Other
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Next
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Birth - City & State
*
Please list the names of the Godparent(s) or sponsor(s). For spouses, please list them together on one line.
*
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
The email provided is:
*
Mom's email
Dad's email
Belongs to both parents
Phone Number
*
Please enter a valid phone number.
The cell phone provided is:
*
Mom's cell
Dad's cell
Please help us understand your relationship to St. Philip the Deacon:
*
Please Select
We are members.
We are former members.
We have parents (or other relatives) who are members.
We are non-members, interested in membership.
If your parents or relatives who attend St. Philip the Deacon, please note them here so that can better understand your connection.
Is there anything you would like us to know?
Submit
Should be Empty: