LUMC Baptism Request Information

Date of Baptism

Service Time

1st Service (8:30) 2nd Service (10:30) Other (provide details below)

Full Baptismal Name (First, Middle, Last)

Date of Birth

Place of Birth (Hospital, City, State, County)

Mother's Name (As you would like it to appear on Baptism Certificate)

Mother Church Member?

Yes No

Father's Name (As you would like it to appear on Baptism Certificate)

Father Church Member?

Yes No

Home Address (include City & Zip code)

Contact Phone #

Contact Email

This address will receive a confirmation email

Other Comments (sponsors, godparents, etc.)

Description

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