Request Form

BaptismForm

Salem Lutheran Church, Albert Lea
Date of Baptism *

Month Day Year
Baptism is for

a child an adult
Full name of person to be baptized. *
Gender *

Male Female
Place of birth *
Date of birth *

Month Day Year
Address *
City, State, Zip *
Parent #1 Name *
Phone Number *
Cell Phone Home Phone
E-mail *
Member of Salem? *

Yes No
Parent #2 Name
Phone Number
Cell Phone Home Phone
Member of Salem?

Yes No
E-mail
Sponsor(s) *
Notes or questions
Should be Empty:

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