Baptism Request Form

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[Church Name]
Baptism Request Form
Buried with Him in baptism, wherein also ye are risen with Him through the faith of
the operation of God, who hath raised Him from the dead.
– Colossians 2:12 (KJV)
Requested Date for Baptism:
Service Time:
Information of Person to be Baptized
Full Name
Sex
Date of Birth
City/State of Birth
Address
Phone Number
Email
Please check the ones that apply:
 I’m a member of [Church Name] and I want to be baptized
 I’m a member of [Church Name] and I want to have my child baptized (Fill out the information
below please.)
 I’m not a member of [Church Name] but I want to be baptized – If you’re a member at
another church, what is the name of your church?
Information of Parents if your Child is being Baptized
Father’s Full Name
Mother’s Full Name
Date of Marriage
Address
Phone Number
Email
Child’s Full Name
Child’s Date of Birth
City/State of Birth
Are you a member
of [Church Name]?
 Yes  No
If yes, how long have you been a member:
Information of Godparents
Godfather’s Name
Godmother’s Name
Signature:
If under 18 years of age, Signature of Parent:
Office Use Only
Date of Baptism Approval:
Elder Assisting:
Copies To: Requested Pastor
Officiating Clergy
Revised:

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