Baptism Application

Holy Baptism
Date

Month Day Year
Name of Candidate *

First Name Middle Name Last Name
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Date of Birth *

Month Day Year
Place of Birth (City, State) *
Phone Number *

Area Code Phone Number
Requested Date *
Requested Time *
E-mail Address *
Clergy Officiating
God Parents or Sponsors
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Name

First Name Last Name
Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
If person to be Baptized is under 18
Father's Name

First Name Last Name
Mother's Name

First Name Last Name
__________________________________________________________________________
St. Clement's by-the-Sea Episcopal Church
202 Avenida Aragon ~ San Clemente, CA 92672
Phone: 949.492.3401 ~ www.scbythesea.org ~ info@scbythesea.org
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