Your full name *

First Name

Last Name

Gender *

Male

Female

Rather not say

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Landline phone number

(###)

###

####

Mobile phone number

(###)

###

####

Date of birth

MM

DD

YYYY

Married status *

Married

Single

Living in common law

Widowed

Separated

Divorced

Or tick this box to indicate you haven't been baptised:

No previous baptism

Your Sponsor's Name

First Name

Last Name

The information given above may be held securely by the Parish and that some or all of the conditions as set out in the UK Data Protection Act 2018 may apply”. *

I have read and agree with the above statement.

Today's date *

MM

DD

YYYY