Checklist for Baptism

( Complete and return this form to the church as soon as possible )

Date and Time confirmed for: ______________________________________________

Check One:

_________ Parents are members of St. George and have a stewardship card on file

_________ Parents are members of _________________________

Orthodox Church in (city/state) __________________________________________.

Parish Priest has been requested to send a confirmation letter.

Baptismal Certificate Information

Father’s Name: ______________________________ Faith of Father: __________________

Father’s Place of Birth: ________________________________________________________

Father’s Current Address: _____________________________________________________

Mother’s Maiden Name: ______________________ Faith of Mother: _________________

Mother’s Place of Birth: _______________________________________________________

Name of Godparent(s): ________________________________________________________

Child is: ______(male) _____(female)

Child’s Date and Place of Birth: ________________________________________________

Wedding Performed by: _____ Orthodox Priest ______ Minister ______

Civil Official Date and Place of Wedding: _______ _____________________________________________

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