Child's Name (First, Middle, Last) *
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Date of Birth
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YYYY
Gender *
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Date of Baptism
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YYYY
Place of Birth (City & State) *
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Mother's Name (First & Last) *
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Address *
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Mother's Phone Number *
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Mother's Email *
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Father's Name (First & Last) *
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Address
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Father's Phone Number *
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Father's Email *
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Marital Status *
Do both parents reside in the same home as child? *
Are you a member of St. John's Lutheran Church *
Godparent(s)
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