Baptism | First Rockwall

Person to be Baptized *

First

Middle

Last

As it would appear on the certificate

Request Date of Baptism *

Requested Worship Service *

Requested Minister to Perform the Baptism

Email *

Phone *

Date of Birth

Place of Birth | County

Father's Name

As it would appear on the certificate

Mother's Name

As it would appear on the certificate

Address

Address Line 1

City

State

Zip Code

Number of Family/Friends that will be in attendance

Any Special Accommodations Needed?

Additional information that would be helpful for us to know: