Baptism Request

Please fill out all the information on this form and submit online to Immanuel Lutheran Church.

Please note *fields are required.

Alternatively, you may download the PDF form, fill out and send or drop off at Immanuel Lutheran Church.
Address:

600 SW 4th Street
P. O. Box 98
Crosby, Minnesota 56441

Child Information

Child's Last Name *

Child's First Name *

Child's Middle Name *

Date of Baptism *

Location for Baptism *

Child's Date of Birth *

Place of Birth *Hospital City County State

Father: Last Name, First, Middle *e.g. Doe, John, Allan

Father's Date of Birth *

Month *

Day *

Year *

Father's Place of Birth *City, State

Mother: Last Name, First, Middle *e.g. Doe, Susan, Mae

Mother's Date of Birth *

Month *

Day *

Year *

Mother's Place of Birth *City, State

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Phone *Main Contact Phone

PhoneAlternate Contact Phone

Email Address *Primary Email Address

Email AddressAlternate Email Address - if applicable