Person to be Baptized (Full name): If child Mother's Maiden Name: Father's Name (Full Name) Candidate Address: Candidate City ST Zip: Candidate Phone: Candidate Date of Birth: Place of Birth: Sex: If different from above: City ST Zip Godparents or Sponsors (Must be practicing Christians who believe in infant Baptism.) Sponsor Name #1: Sponsor #1 Address: Sponsor #1 City ST Zip: Sponsor #1 Church Affiliation: Sponsor Name #2: Sponsor #2 Address: Sponsor #2 City ST Zip: Sponsor #2 Church Affiliation: Security code:   * Do not enter anything in this field:

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