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L L 𫐀" R 8 y 0 6 , N N x : Baptism Information Form
Your Name: ________________________________________
Mailing address:___________________________________________________________
City, State, Zip:___________________________________ _______ ________________
Phone: (_____) _______________________________
E-Mail: _______________________@______________________ . __________
Date of Sunday you are requesting the baptism? ___________
For Infant or Young Child:
Child's Full Name: _________________________________________________________
Date of Birth: ________________________ What city? _______________________
Fathers Name: ______________________________________
Mothers Name: ______________________________________Maiden:____________
Is there family church affiliation? Y N; Denomination: _________________________
Witnesses are not required, but are recommended.
Names: ______________________________Relationship______________________
______________________________Relationship______________________
Sponsors [members of the church]:
Names: ______________________________Relationship______________________
______________________________Relationship______________________
For Adults
Full Name: _____________________________________ Maiden Name______________
Date of Birth: ________________________
What city of birth? _______________________
Fathers Name: ______________________________________
Mothers Name: ______________________________________
Mothers Maiden Name________________________
-------------------------------------------------------------------------------------------------------------
OFFICE:
____Bulletin Information _____Recorded in System _________Certificate prepared
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