Form
Name of Child
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Place of Birth
Mother's Name
First Name
Last Name
Father's Name
First Name
Last Name
Sponsor or Witness
First Name
Last Name
Godparent
First Name
Last Name
Baptized?
Yes
No
If yes, what denomination?
Are you a member of this church?
Yes
No
If you are not a member, are you related to a member?
If none of the above, are you (or sponsor/Godparent) a confirmed Episcopalian?
Yes
No
Contact
Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Contact Email Address
example@example.com
Desired Date of Baptism
-
Month
-
Day
Year
Date
Submit
Should be Empty: