Baptism Application

Holy Baptism
Date

MonthDayYear
Name of Candidate*

First NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Date of Birth*

MonthDayYear
Place of Birth (City, State)*
Phone Number*

Area CodePhone Number
Requested Date*
Requested Time*
E-mail Address*
Clergy Officiating
God Parents or Sponsors
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Name

First NameLast Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
If person to be Baptized is under 18
Father's Name

First NameLast Name
Mother's Name

First NameLast Name
__________________________________________________________________________
St. Clement's by-the-Sea Episcopal Church
202 Avenida Aragon ~ San Clemente, CA 92672
Phone: 949.492.3401 ~ www.scbythesea.org ~ info@scbythesea.org
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