Language
English (US)
Immanuel Lutheran Church
Application for Infant/Child Baptism
Child's Full Name
*
first, middle, last name
Date of Birth
*
-
Month
-
Day
Year
Date
Place of Birth
*
city and state
Child's Gender
*
Father's Name
First Name
Last Name
Mother's Name
First Name
Last Name
Mother's Maiden Name
Address of Parents
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date Requested for Baptism
-
Month
-
Day
Year
Date
Preferred Phone Number
*
-
Area Code
Phone Number
Alternate Phone Number
-
Area Code
Phone Number
Preferred Email
*
example@example.com
Alternate Email
example@example.com
Full Names of All Sponsors
Submit
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