Application for Baptism

Application for Holy Baptism

* Indicates required field

Candidate's Name *

Date of Birth *

Place of Birth *

Parent # 1 Name *

If yes, please tell us the Church Name, City, and Date *

Have you been baptized? *

Yes No

Parent # 1 Phone Number *

Parent # 1 Email *

Parent # 2 Name *

If yes, please give tell us the Church Name, City, and Date *

Have you been baptized? *

Yes No

Parent # 2 Phone Number *

Parent # 2 Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Sponsors (each Candidate must have at least one sponsor who is baptized) *

Submit

2640 Park Drive
P.O. Box 25
Flossmoor, Illinois 60422
(708) 798-4150
office@mysje.org

The Very Rev'd. Jeremy C. Froyen, CFC
Rector