Baptism Request Form

CHILD'S INFORMATION

Child's First Name REQUIRED Please fill out this field. Please enter valid data.
Child's Middle Name REQUIRED Please fill out this field. Please enter valid data.
Child's Last Name REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Child's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Child's City of Birth REQUIRED Please fill out this field. Please enter valid data.
Name of School and Grade (if applicable) Please enter valid data.

GODPARENT INFORMATION (if unknown, please type TBD)

First and Last Name of Godfather REQUIRED Please fill out this field. Please enter valid data.
Godfather's Religion (ex. Catholic, Baptist, United, Anglican, Not-baptized, etc) REQUIRED Please fill out this field. Please enter valid data.
First and Last Name of Godmother REQUIRED Please fill out this field. Please enter valid data.
Godmother's Religion (ex. Catholic, Baptist, United, Anglican, Not-baptized, etc) REQUIRED Please fill out this field. Please enter valid data.
Are Godparents married to one another? Yes No

FATHER'S INFORMATION

Father's First and Last Name (as listed on child's birth certificate) REQUIRED Please fill out this field. Please enter valid data.
Father's Phone Number REQUIRED Please fill out this field. Please enter valid data.
Email Please enter an email address.
Father's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Father's Religion (ex. Catholic, Baptist, United, Anglican, Not-baptized, etc) REQUIRED Please fill out this field. Please enter valid data.

MOTHER'S INFORMATION

Mother's First and Last Name (as listed on child's birth certificate) REQUIRED Please fill out this field. Please enter valid data.
Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
Mother's Phone Number REQUIRED Please fill out this field. Please enter valid data.
Email Please enter an email address.
Mother's Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Mother's Religion (ex. Catholic, Baptist, United, Anglican, Not-baptized, etc) REQUIRED Please fill out this field. Please enter valid data.

FAMILY INFORMATION