Name, Person To Be Baptized *

First Name

Last Name

Name, Parent/Guardian, If Applicable

First Name

Last Name

Phone *

Your number is requested to set up a meeting to discuss the Baptism with a church Ministerial representative.

(###)

###

####

Date Requested for Baptism

MM

DD

YYYY

Which Service

During which service would the person like to be baptized?

First Service

Second Service

Name, Of The Person To Perform The Baptism

First Name

Last Name

Name, Of The Person To Pray For The Baptism

First Name

Last Name