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
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:*
Date of Baptism:*
City and State:*
Check one:*

ConfirmationReception
Sponsor: The Reverend Brian G. Rallison

Father Brian will always be the sponsor.
If confirmed before, what denomination? Please also put the date and the name of the church where it took place:
Should be Empty: