Infant/Child Baptism Request Form

Infant/Child Baptism Form
Date

Month Day Year
Date
Member

Yes No
Parent(s) Name(s)
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Contact Number

Area Code Phone Number
Email
example@example.com
Child's Name
Date of Birth

Month Day Year
Date
God Parents' Name(s)
Other Information
(i.e.grandparents, etc)
Number of Attendees:
Date requested for Baptism Service*

Month Day Year
Date
Upon completion of this form, you will be contacted with the date of the baptism service. If there are any questions, you may contact Rev. Charmain Purvis at 404-827-9707 ext.105