Confirmation, Reception, Baptism, and Reaffirmation Form - The Episcopal Parish of St. Clement

Please provide the following information. If you need help with this form, please get in touch with Leesa Steadman, Parish Administrator, at admin@StClem.org

Proposed Date of Baptism:

Date

Proposed Time for Baptism:

Name of Candidate:

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.

E-mail*

Candidateʻs Gender:

Candidateʻs Date of Birth:

Candidateʻs Birthplace:

Comments

Parent 1 - Full Name:

Parent 1 - Address:

Parent 1 - Church Affiliation:

Parent 2 - Name:

Parent 2 - Address:

Parent 2 - Church Affiliation:

What is the name of the Church that the parents now attend?

How long have you attended?

Why do you wish to be baptized at St. Clment?

Have you had other children baptized at St. Clement?

YesNo

If the answer is YES to the prior question, please list names and dates:

Other Relevant Family Information:

Please list your childrenʻs proposed Godparents - Name and Church Affiliiation: