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Baptism Request Form
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* Indicates required question
Email
*
Your email
Primary phone
*
no spaces or punctuation
Your answer
Street Address
*
Your answer
City
*
Your answer
ST
*
Your answer
Zip
*
Your answer
Mother's full name
*
Your answer
Father's full name
*
Your answer
Child's first, middle and last name
*
Your answer
Child's birth date
*
MM
/
DD
/
YYYY
Requested baptism date
*
MM
/
DD
/
YYYY
Requested pastor
*
Your answer
Any other information you'd like to share
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