Name of person to be baptized (required)

Gender (required)

Birthday YYYY-MM-DD (required)

Birth City and State (required)

If minor, names of mother and father

Mother's Name (required)

Mother's Phone

Mother's Email

Mother's Address

Father's Name (required)

Father's Phone

Father's Email

Father's Address

Please list any siblings and their birthdays

Sponsors' names

Special Requests

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