Baptism Request - Alto Reformed Church

Request for Baptism

* Indicates required field

Name of Person to be Baptized (First, Middle, Last) *

Date of Birth (MM/DD/YYYY) *

Baptism Date(s) Requested *

Place of Birth (Hospital) *

Mother's Name *

First

Last

Father's Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Assisting Elder (if you have a preference) *

Phone Number *

Email *

Submit