Crossroads Baptism For Children
Instructions: Please provide the following information so that your child(ren) can be properly recognized and honored during the service.
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General Information for Parents of Child(ren) Being Baptized
Full Name of Parent 1: *
Parent 1 Address: *
Parent 1 Phone Number:
 *
Parent 1 Email:
 *
Full Name of Parent 2:
Parent 2 Address (if different):
Parent 2 Phone Number:
Parent 2 Email:
Baptism Service
Date of Baptism Workshop:
 *
MM
/
DD
/
YYYY
Date of Baptism Celebration:
 *
MM
/
DD
/
YYYY
Please select which worship service you will attend for  the Baptism Celebration:
 *
Number of Reserved Seats Needed for Baptism Celebration:
 *
Please let us know the names of all family members that are attending the baptism service and are coming up onto the platform:
For the Child Being Baptized
Full Name of Child (First, Middle, Last):
 *
Date of Birth:
 *
MM
/
DD
/
YYYY
If applicable
For the 2nd Child Being Baptized
Full Name of Child (First, Middle, Last):
Date of Birth:
MM
/
DD
/
YYYY
If applicable
For the 3rd Child Being Baptized
Full Name of Child (First, Middle, Last):
Date of Birth:
MM
/
DD
/
YYYY
Information About Other Children (not being baptized- if applicable)
Name of Child:
Date of Birth:
MM
/
DD
/
YYYY
Baptized?
Clear selection
If Yes, Date and Church Name
Information About Other Children (not being baptized- if applicable)
Name of Child:
Date of Birth:
MM
/
DD
/
YYYY
Baptized?
Clear selection
If Yes, Date and Church Name
Information About Parent 1
How long have you been attending Crossroads? 
Have You Been Baptized?
Clear selection
Date of Baptism:
Church Name:
Information About Parent 2
How long have you been attending Crossroads?
Have You Been Baptized?
Clear selection
Date of Baptism:
Church Name:
Submit
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