Information for Baptism

(Please print names as they should appear on certificates)

Date of Baptism: _________________- at the ________________ service.

Full name of person to be baptized:

Date of Birth: ___________________________ Place of Birth: _______________________________

Name of Father: _____________________________________ Church membership:_________________

Name of Mother: _____________________________________ Church membership:_________________

Address: _____________________________________________

_____________________________________________________

Phone: _______________________________ E-mail: _______________________________

Sponsor: ___________________________________________ Church membership: ________________

Questions, notes or special concerns, if any:

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