test – Holy Sacrament Episcopal Church

Baptism Candidate's Information

Date of Application

Candidate's Name

First

Middle

Last

Date of Birth

Age

Place of Birth (city and state):

Gender

Male
Female

Birth Certificate:

Click or drag a file to this area to upload.

Mother's Information

Mother's Full Name

First

Middle

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Phone Number:

Email

Confirm Email

Mother Baptized?

Yes
No

Father's Full Name:

First

Middle

Last

Address (same as above)?

Yes
No

Phone

Email

Confirm Email

Father Baptized?

Yes
No

Godparent's Information

Godparent's Name (#1):

First

Last

Godparent's Email (#1):

Email

Confirm Email

Godparent's Name (#2):

First

Last

Godparent's Email (#2):

Email

Confirm Email

Godparent's Name (#3):

First

Last

Godparent's Email (#3):

Email

Confirm Email

Godparent's Name (#4):

First

Last

Godparent's Email (#4):

Comment or Message:

If you have additional Godparents, please leave their name and email here.