Holy Baptism Information Intake
Please fill out this form and click submit.
We'll need some general information for our church records and baptism certificate.
Full Name of Adult or Child (include middle name)
*
Address
*
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AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Date of Birth
*
Place of Birth
*
Parent (1) Full Name (for record book)
*
Parent (2) Full Name (for record book)
*
Parents' Residence (if different)
*
Religious Affiliation of Parents
*
Phone
*
Email
*
This address will receive a confirmation email
Witness or Godparents - you may list up to 3
Name & Address
*
Name & Address
Name & Address
The Day of Baptism
Date of Baptism
*
Hour of Baptism
*
Submit
Description
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