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PHILADELPHIA PRESBYTERIAN CHURCH BAPTISMAL REQUEST FORM Date Request Received at PPC ____\____\____ Requested Dates 1. ____\____\____ 2. ____\____\____ 3. ____\____\____

10:30 a.m. 10:30 a.m. 10:30 a.m..

Child’s Full Name: _____________________________________________Gender: ___ Birth Date: ____\____\____ Place of Birth: _____________________________ Father’s Full Name: ________________________________________Goes By: _______ Mother’s Full Name: _______________________________________Goes By: _______ Address: ________________________________________________________________ Phone: (h) ______________________ Phone: (w) Mother: ________________________ Phone: (w) ______________________ Members of PPC Since: ___________________ Name(s) of Siblings

Age

_________________________

____

______________________

_________________________

____

______________________

_________________________

____

______________________

Name of Elder __________________________

Baptized at PPC?

Relationship ___________________

Elder’s Church ____________________

Please return the request form to the Pastor at the church office at least one month prior to the date you are requesting. 10/7/02 cs