Full name of person to be baptised *

First Name

Last Name

Date of their birth *

MM

DD

YYYY

Person to be baptised is: *

ADULT (18yrs and over)

CHILD (under 18yrs)

I AM THIS PERSON – I am ADULT

Baptism service time *

St James : 10.00am (during service)

St James : 12 noon (private)

St Annes : 8.30am (during service)

St Anne’s: time to be arranged (private)

Name of Mother / Parent A *

First Name

Last Name

Address where they live *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

Are they baptised? *

Yes

No

Name of Father / Parent B *

First Name

Last Name

Address where they live *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

Country

(###)

###

####

Are they baptised? *

Yes

No

Godparent 1

(optional - can be advised later)

First Name

Last Name

Are they baptised?

Yes

No

Godparent 2

(optional - can be advised later)

First Name

Last Name

Are they baptised?

Yes

No

Godparent 3

(optional - can be advised later)

First Name

Last Name

Are they baptised?

Yes

No

Godparent 4

(optional - can be advised later)

First Name

Last Name

Are they baptised?

Yes

No

More than 4 Godparents? *

Yes

No

My commitment *

I undertake to ensure that this adult/child is instructed in the Christian Faith, according to the teaching of the Anglican Church, and they will be brought to the Bishop for confirmation as the Prayer Book directs. This Baptism will be recorded in the Parish and Diocesan records.