Request for Infant/Child Baptism

Name of infant/child being baptized (First, Middle, Last):

Birthdate:

Place of birth (city & state):

Ethnicity:

Name of Parent(s):

Home Address:

Best Contact Number:

This address will receive a confirmation email

Church Affiliation (if not a member of UMCNB):

Grand Parents (if applicable)

God Parents/Sponsors (if applicable):

Requested date of baptism:

FOR OFFICE USE ONLY

Date to be performed:

Date certificate prepared:

Date entered into Breeze:

Date added to conference booklet:

Description

Please fill out and submit this form for a baptism request.