Baptism Registration Form
Full Name:
*
City:
*
Child's Name:
*
First Name
Last Name
Date of Birth:
*
-
Month
-
Day
Year
Date
Birth Place:
*
Mother's Name:
*
First Name
Last Name
Father's Name:
*
First Name
Last Name
Emergency Contact information:
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Are parents married?
Yes
No
Family Contact Information
Phone Number:
Please enter a valid phone number.
Email Address:
example@example.com
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Briefly share your testimony (optional)
Do you have any Health Concerns (Yes/No) Please provide:
*
Shirt Size (optional)
Guest total
*
Please input the total amount that will attend
Date:
-
Month
-
Day
Year
Date
Parent Signature:
Submit
Submit
Should be Empty: