Form – TerraUtopia

Date of Baptism

Child's First Name

Child's Middle Name

Child's Last Name

Child's Date of Birth

City of Birth

Birthplace / Hospital Name

Birthplace / Hospital Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Parent's Information

Parent's First Name

Parent's Middle Name

Parent's Last Name at Birth

Is parent a member of the United Church of Canada?

Yes

Where is parent a member?

Parent's First Name

Parent's Middle Name

Parent's Last Name at Birth

Is parent a member of the United Church of Canada?

Yes

Where is parent a member?

Home Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Home Phone

Other Phone

Witnesses / Godparents

Witness #1 First Name

Witness #1 Last Name

Witness #1 Home Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

Witness #2 First Name

Witness #2 Last Name

Witness #2 Home Address

Address Line 1

Address Line 2

City

Province / State

Postal / Zip Code

Country

How can we help?

Please fill out this section if you would like us to contact you.

We are searching for Spiritual growth

We are newcomers to the community

We are interested in becoming members

We would like to receive the church newsletter

We would like to speak with the minister when convenient for both of us

Email address for Church Newsletter

Number for minister to contact us at

When should the minister call?