Please fill out the information for the person wishing to be baptized. 

Adult (19+)
Youth (7th Grade-12th Grade)
Child (19 mos.-6th Grade)
Infant (birht-18 mos.)

Full Name:
Preferred Name:
Date of Birth:
Place of Birth:
Street Address/Apt #:
City/State/Zip:
Home Phone:
Work Phone:
E-mail:

Are you a member of Floris UMC? Yes  No

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

Names of Parents:
 (mother)
 (father)

Names of Godparents: (optional)
 (Godmother)
 (Godfather)