Baptism Request - Peace Lutheran

Name of the Person Desiring Baptism*
First (Required) Middle (Required) Last (Required)
Preferred Date for the Baptism*
MM slash DD slash YYYY
Secondary Date for the Baptism
MM slash DD slash YYYY
Preferred Time for the Baptism*
- 8:00 am
- 10:30 am
- 9:00 am Summer Worship Time
- Special Service [Only with pre-approval from the Pastor]
Birth Date*
MM slash DD slash YYYY
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?*
- Yes
- No
Name of the Sponsor/Godparents*
First Last
Sponsor's Church Membership*
Name of the Sponsor/Godparents
First Last
Sponsor's Church Membership
Name of the Sponsor/Godparents
First Last
Sponsor's Church Membership
Name of the Sponsor/Godparents
First Last
Sponsor's Church Membership
Name of the Sponsor/Godparents
First Last
Sponsor's Church Membership
Name of the Sponsor/Godparents
First Last
Sponsor's Church Membership