Baptist Convention Of South Sudan
Date of Request
Full Name of Person to be Baptized
Date of Birth
Place of Birth
Sex MaleFemale
Home Address
Phone (Home)
Phone (Work)
Father’s Information
Last Name
Middle Name
First Name
Religion
Occupation
Marital Status SingleMarried – CivilCommon-lawMarried – Catholic ChurchMarried – MinisterSeparatedDivorced – SingleDivorced – Remarried
Mother’s Information
Last Name (Maiden)
Marital Status
Are you a registered member of a parish? [radio* parish-member use_label_element "Yes" "No"]
If yes, name of the parish
Do you attend church regularly? YesNo
Are you ready to raise this child in the faith? YesNo
Godparent 1 Name
Godparent 1 Religion
Godparent 2 Name
Godparent 2 Religion
Proxy Name (if needed)
Proxy Religion
Baptism Session 1 (Date & Time)
Baptism Session 2 (Date & Time)
Baptism Session 3 (Date & Time)
Date of Baptism
Time of Baptism
Priest's Name
