Request for Holy Baptism
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
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service