Baptismal Application

Desired Date of Baptism *

Date

Time

Name of Candidate for Baptism *

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Place of Birth *

City, State

Date of Birth *

Phone

Email *

Father's Name

First

Last

Father's Faith

Mother's Name

First

Last

Mother's Faith

Does the baptismal candidate have a godfather?

Name

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