Episcopal Diocese of Virginia
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Information Form for Holy Baptism

(* Denotes Required Fields)

Please complete the following information.

Your name: *
Your email: *
Full name of candidate: *
Gender: *  
Date of birth of candidate: *
City/State/Country of Birth of Candidate: *
Full address of candidate: *
Telephone number with area code: *
Email address of candidate:
Father's full name: *
Mother's full name: *
Religious affiliation of parent(s) if candidate is a minor: *
Sponsors or Godparents: *
Date(s) preferred for Baptism:
Service time preferred:
Place of baptism:

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