Baptism Information Form – Pieces of My Life

Baptism Form

Date of Baptism

Child's First Name

Child's Middle Name

Child's Last Name

Child's Date of Birth

City of Birth

Birthplace / Hospital Name

Birthplace / Hospital Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Parent's Information

Parent's First Name

Parent's Middle Name

Parent's Last Name at Birth

Is parent a member of the United Church of Canada?

Yes

Where is parent a member?

Parent's First Name

Parent's Middle Name

Parent's Last Name at Birth

Is parent a member of the United Church of Canada?

Yes

Where is parent a member?

Home Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Home Phone

Other Phone

Witnesses / Godparents

Witness #1 First Name

Witness #1 Last Name

Witness #1 Home Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Witness #2 First Name

Witness #2 Last Name

Witness #2 Home Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Parent's Information

Witnesses / Godparents

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