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
Location of Birth (Hospital) *
Your answer
City and State of Hospital/Birth Place *
Your answer
Mother's Full Name *
Your answer
Father's Full Name *
Your answer
Address *
Your answer
E-mail Address *
Your answer
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: *
Your answer
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