Infant or Child Baptism Request Form

Child's Full Name (First, Middle, Last)*
Child's Date of Birth*
Mother's First and Last name
Contact Number*
Email Address
Have you prayed the Prayer of Salvation and confessed Jesus Christ as Lord and Savior over your life? (Are you saved?)*
 Yes
 No
Father's First and Last Name*
Contact Number*
Email Address
Have you prayed the Prayer of Salvation and confessed Jesus Christ as Lord and Savior over your life? (Are you saved?)*
 Yes
 No
Why do you desire for your child to be baptized?*
Godmother's First and Last Name
Has she prayed the Prayer of Salvation and confessed Jesus Christ as Lord and Savior over her life? (Is she saved?)
 Yes
 No
Godfather's First and Last Name
Has he prayed the Prayer of Salvation and confessed Jesus Christ as Lord and Savior over his life? (Is he saved?)
 Yes
 No
What date do you desire to have your child baptized?*
Light of the World Outreach Center cannot guarantee the date you have requested. We will make every effort to accommodate your request.*


Submit