Child Baptism Request Form

Child Baptism Request Form

Please provide the following information to request a baptism for your child.
Child's Full Name*

First NameMiddle NameLast Name
Child's Date of Birth*

MonthDayYear
Date
Requested Date for Baptism*

MonthDayYear
Date
Child's Place of Birth*
Father's Full Name*

First NameLast Name
Father's Place of Birth*
Father's Church Membership
Father's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Father's Phone Number
Please enter a valid phone number.
Father's Email
example@example.com
Mother's Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Mother's Phone Number
Please enter a valid phone number.
Mother's Email
example@example.com
Mother's Full Name*

First NameLast Name
Mother's Church Membership
Mother's Place of Birth*
Names of Baptismal Sponsors (Godparents)*
Should be Empty: