Contact Information
Contact Name
First Name
Last Name
Contact Email
example@example.com
Contact Phone
Please enter a valid phone number.
Format: (000) 000-0000.
Baptism Information
Person requesting to be baptized
First Name
Last Name
Shirt Size
Please Select
Child Small
Child Medium
Child Large
Adult Small
Adult Medium
Adult Large
Adult XL
Adult XXL
Adult 3XL
We will be providing you with a special shirt for the occasion
Please type out how you would like the name to be listed on the Baptism Certificate.
Is this person under 18?
Yes
No
What is their birthdate?
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
What grade are they in?
Please Select
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Fifth Grade
Sixth Grade
Seventh Grade
Eighth Grade
Ninth Grade
Tenth Grade
Eleventh Grade
Twelfth Grade
College
Not Applicable
There are approximately 15 steps to get into the baptistry. Will you need any physical assistance with this?
Yes
No
Is there anything else you would like to share with us?
Date
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Submit
Should be Empty: