Application for Baptism

Pastor Performing Baptism: *
What date would you desire for the baptism?: * mm/dd/yyyy
Which service would you desire?: 8:30 Traditional Service 11:00 Contemporary Service
Name of person being baptized: * First Middle Last Suffix
Address *
Street Address

Address Line 2
City State Postal / Zip Code
Home Phone: ### ###-####
Work Phone: ### ###-####
Email Address: *
If child, please complete the following:
Date of birth: mm/dd/yyyy
Place of Birth:
Father's Full Name:
Check if Father is a member
Mother's Full Name (Maiden):
Check if Mother is a member
If you are using sponsors, please fill out the section below:
Please indicate: Mr., Mrs., Miss, or Ms., or Mr. & Mrs.
Sponsor 1:
Name
Address
Street Address

Address Line 2
City State Postal / Zip Code
Sponsor 2:
Name
Address
Street Address

Address Line 2
City State Postal / Zip Code
Sponsor 3:
Name
Address
Street Address

Address Line 2
City State Postal / Zip Code
Sponsor 4:
Name
Address
Street Address

Address Line 2
City State Postal / Zip Code
Cancel and close without submitting