Messiah Lutheran Church Baptism Personal Record
Baptism Date
*
-
Month
-
Day
Year
Date
Worship Service Time
*
Hour Minutes
AM
PM
AM/PM Option
Full Name of Baptized
*
Gender
*
Male
Female
Prefer not to disclose
Other
Date of Birth
*
-
Month
-
Day
Year
Date
City and State of Birth
*
City, State
Name of Parent 1
*
First Name
Last Name
(Parent 1)Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
(Parent 1) Email
*
example@example.com
(Parent 1) Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Name of Parent 2
First Name
Last Name
(Parent 2)Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
(Parent 2) Email
example@example.com
(Parent 2) Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sponsor 1 Name
*
First Name
Last Name
(Sponsor 1) Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
(Sponsor 1)Email
example@example.com
(Sponsor 1) Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Sponsor 2 Name
*
First Name
Last Name
(Sponsor 2) Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
(Sponsor 2)Email
example@example.com
(Sponsor 2) Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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