Baptism Request - Peace Lutheran Church

Name of the Person Desiring Baptism*

First (Required) Middle (Required) Last (Required)

Preferred Date for the Baptism*

Secondary Date for the Baptism

Preferred Time for the Baptism*

Birth Date*

Birth City*

Father's Name*

First Last

Mother's Name*

First Last

Address*

Street Address City State / Province / Region ZIP / Postal Code

Phone*

Email*

Are you (or the parents of the child) a current member of Peace Lutheran?*

Name of the Sponsor/Godparents*

First Last

Sponsor's Church Membership*