Baptism Form

Formal Name of Child/Person to be Baptized*

This field is required. Please enter First Middle and Last name.

Preferred Name

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Relation*

Son

Daughter

Self

This field is required.

Date of Birth*

This field is required.

Place of Birth*

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Address*

This field is required. Please enter: Street City, State, Zip

Home Phone Number

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Formal Name of Parent 1*

Invalid Input

Preferred Name

Invalid Input

Maiden Name (if applicable)

Invalid Input

Is this parent a BMPC member?*

Yes

This field is required.

If not a member, name and location of church of membership.

Invalid Input

Parent 1 Date of Birth*

Invalid Input

Parent 1 Phone Number*

This field is required. Please enter in the format: XXX-XXX-XXXX

Parent 1 Email Address*

Invalid Input

Formal Name of Parent 2

Invalid Input

Preferred Name

Invalid Input

Maiden Name (if applicable)

Invalid Input

Is this parent a BMPC member?

Yes

Invalid Input

If not a member, name and location of church of membership.

Invalid Input

Parent 2 Date of Birth*

This field is required.

Parent 2 Phone Number

Invalid Input

Parent 2 Email Address

Invalid Input

Does the person being baptized have siblings?*

Yes

This field requires a selection.

If yes, enter the names and birth dates of siblings.

Invalid Input

Are grandparents of the person being baptized BMPC members?*

Yes

Some

This field requires a selection.

If yes or some, enter the names of grandparents.

Invalid Input

Baptism Request Form

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