CONFIRMATION/RECEPTION/REAFFIRMATION/BAPTISM RECORD

Episcopal Diocese of Central Pennsylvania

Church: Click or tap here to enter text.	City: Click or tap here to enter text.

Clergy or Lay Person in Charge: Click or tap here to enter text.

Date of Visit: Click or tap to enter a date.

☒ VISITATION ONLY. Please check if no confirmations, receptions, reaffirmations, or baptisms.

TO BE CONFIRMED:

NAME	AGE	CHURCH OF BAPTISM

TO BE RECEIVED:

NAME	AGE	CHURCH OF BAPTISM	CHURCH OF CONFIRMATION

REAFFIRMATION OF CONFIRMATION VOWS:

NAME	AGE	ADDRESS

BAPTISM:

NAME	AGE	ADDRESS

Please return this form to the Bishop’s Office for our records before the scheduled visitation