Baptism & Baby Dedication Request Form
Please submit this form no later than the Sunday before the baby dedication/baptism so that we can properly prepare. We will call or e-mail you to confirm your baptism/dedication has been scheduled.
Date requested
*
-
Month
-
Day
Year
Date Picker Icon
Candidate is
*
a child
an adult
Candidate's Full Name
*
First Middle Last
Gender
*
Male
Female
Date of birth
*
-
Month
-
Day
Year
Date Picker Icon
Member of The MetroCocoa
*
Yes
No
Parent/Guardian Information
Mother's name
*
Father's name
*
Member of MetroCocoa
*
Yes
No
Address
*
City, State, Zip
*
Phone Number
*
Mobile Number
*
E-mail
*
Notes or questions
For Office Use Only
Dated Baptized or Dedicated
-
Month
-
Day
Year
Date
Baptized/Dedicated by:
Pastor Steve A. Brock
Other
Certificate Given to Member
Yes
No
Notes/Comments
Submit
Should be Empty: