BaptismForm

Immanuel Lutheran Church

Application for Infant/Child Baptism
Child's Full Name
first, middle, last name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Place of Birth
city and state
Child's Gender
Father's Name

First NameLast Name
Mother's Name

First NameLast Name
Mother's Maiden Name
Address of Parents

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date Requested for Baptism

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Preferred Phone Number

Area CodePhone Number
Alternate Phone Number

Area CodePhone Number
Preferred Email
example@example.com
Alternate Email
example@example.com
Full Names of All Sponsors
Should be Empty:

Immanuel Lutheran Church