• Adult (19+)

• Youth (7th Grade-12th Grade)

• Child (19 mos.-6th Grade)

• Infant (birth-18 mos.)

Full Name (First, Middle, Last):

Preferred Name:

Gender:

Choose... Male Female

Date of Birth:

Place of Birth:

Street Address with Apt #:

City/State/Zip:

Home Phone:

Work Phone:

E-mail:

Are you a member of Floris UMC?

Choose... Yes No

If the Baptism request is for a minor, please enter the information below.

Mother's Name:

Father's Name:

Name of Godparents (optional):

Godmother's Name:

Godfather's Name: