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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