Baptism Request Form

Details About the Baptism
Child's Name

First NameMiddle NameLast Name
Child's Date of Birth

MonthDayYear
Child's Place of Birth
i.e.: Eau Claire, Madison, Toledo, etc.
Parent's Name

First NameMiddle NameLast Name
Parent's Name

First NameLast NameMaiden Name (if applicable)
Parent's Name

First NameLast NameMaiden Name (if applicable)
Address of Parents

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number

Area CodePhone Number
E-mail
Date of Baptism

MonthDayYear
Time of Baptism
8:15 a.m. OR 10:45 a.m. (Winter Hours); 9:00 a.m. (Summer Hours-begin mid-May, end mid September)
Names of Sponsors & Their Church Membership (Name & Place)
Congregational Representative
(Someone you know in the church who can present the Baptism candle)
Special Requests
Should be Empty:

Details About the Baptism