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Worship >  Baptism Registration Form > 

Baptism Form

Please complete the information below regarding your child’s baptism at The Brick Presbyterian Church and return it to Lena Tharp. Please note that submission of this form does NOT guarantee Baptism on the date requested.  If you have any questions, please call Lena at (212) 289-4400 x246 or e-mail her at ltharp@brickchurch.org.
Name of person to contact about this baptism
First*
Last*
Date of Baptism Desired*
 
Address
Street:*
City*
State*
Zip*
Home Phone*
Mobile Phone*
Email Address*
Full name of person being baptized*
Gender*
Date of Birth*
Place of Birth
(Hospital, City and State)*
Father's Name
Father's Full Legal Name*
Member of The Brick Church
Is the father a member?*
 Yes  No
If no, please state the church of which the father is a member and its denomination.
Father's Cell Phone
Mother's Name
Mother's Full Legal Name*
Mother's Maiden Name*
Member of The Brick Church
Is the mother a member?*
 Yes  No
If no, please state the church of which the mother is a member and its denomination.
Mother's Cell Phone

    
62 East Ninety-second Street, New York, NY 10128-1398 • Tel: 212-289-4400 • Fax: 212-996-7078
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