Baptism Request Form

Child’s First Name *

Child’s Last Name *

Child’s Gender
—Please choose an option—MaleFemale

Child’s Date of Birth

Child’s Place of Birth *

Father’s First Name *

Father’s Last Name *

Mother’s First Name *

Mother’s Last Name *

Parent’s Email *

Parent’s Phone Number *

Parent’s Street Address *

City *

State *
—Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming

ZIP Code *

Godfather’s First Name *

Godfather’s Last Name *

Godfather’s Denomination *
—Please choose an option—Armenian OrthodoxOther OrthodoxCatholicProtestant

Godfather Baptized *
—Please choose an option—YesNo

Godfather Place of Baptism *
—Please choose an option—Holy Trinity Armenian Apostolic Church WorcesterOther

Godmother’s First Name *

Godmother’s Last Name *

Godmother’s Denomination *
—Please choose an option—Armenian OrthodoxOther OrthodoxCatholicProtestant

Requested Date of Baptism *

Requested Time of Baptism *

Your Message (optional)