Baptism Information
Zion Lutheran Church
203 S Vine St.
Mt. Pulaski, IL 62548

Please fill out the following information for your upcoming baptism! Please use full legal names, complete each blank, and double-check spelling so we can fill out the baptism certificate.

Full Name of Child
Your answer
Sex of Child
Date of Baptism
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DD
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YYYY
Date of Birth
MM
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DD
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YYYY
Name of Hospital
Your answer
City and State of Hospital
Your answer
Mother's Full Name
Your answer
Father's Full Name
Your answer
Address
Your answer
E-mail Address
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Phone Number
Your answer
Sponsor's Full Name(s)
Your answer
Please tell us a little about your sponsors and why you chose them as examples of the faith for your child:
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