Name of Child:_______________________________________________

Has your child been baptized? Yes or No

If yes, what was the date?________________________

If No, would you like to learn more about Christian Baptism? Yes or No

Age:__________      Grade:___________

Parents’ Name(s):__________________________________________________________

Address:__________________________________________________________________

Phone Number(s): Home – _______________     Cell - _______________

Email Address:_____________________________________________________________

Allergies:__________________________________________________________________

Anything else we should know about your child… _________________________________

__________________________________________________________________________

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