Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Date of Baptism *

MM

DD

YYYY

If pictures were taken of the event, do you give permission for H.O.W to post on the Church Website and Social Media Pages? *

Yes

No

Please print my baptism certificate in *

(Please select only one choice)

English

Spanish