Baptism Request Form

Baptism Request Form

Applicant's Information

Name *

First

Middle

Middle

Last *

Last

Gender *

Male

Female

Age *

Date of Birth *

Contact Information

Contact Person

if different than applicant

Address *

Address

Address

Address

City

City

State/Province

State/Province

Zip/Postal

Zip/Postal

Phone Number *

Email Address *

Is applicant a child? *

Yes

No

Father's Full Name

Mother's Full Name

Requested Baptism Date

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If you are human, leave this field blank.

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