Request for Holy Baptism
Email address *
Full Name of Person to Be Baptized (Please include middle name.) *
Your answer
Gender *
Date of Birth *
MM
/
DD
/
YYYY
Requested Date for Baptism *
(These dates are based on liturgically appropriate seasons and dates. If the 'other' selection is chosen, additional dates are added at the sole discretion of the Rector.)
Place of Birth *
Your answer
Father's Full Name (as it would appear on the Baptismal Certificate.) *
Your answer
Mother's Full Name (as it would appear on the Baptismal Certificate.) *
Your answer
Contact Information
Address *
Please include city, state, and zipcode
Your answer
Phone Number *
Your answer
Phone Number (alternate)
Your answer
Email Address *
Your answer
Email Address (alternate)
Your answer
Godparent Name
Your answer
Godparent Name
Your answer
A copy of your responses will be emailed to the address you provided.
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