Bethel Lutheran Church                                            New Member - Child Registration
Please complete the following information for each child joining Bethel.
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Child's Name (First, Middle Last): *
Father's Name: *
Mother's Name (including maiden): *
Birthdate: *
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Birth City and State: *
Date of Baptism:
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Baptism Church, City and State:
Date of Confirmation:
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Confirmation Church, City and State:
School Attending:
Grade in School:
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Email Address:
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