Prayer Request Form

Are you in need of prayer? Would you like to add someone’s name to our prayer list? Fill out this confidential form and those names will be added to Bethel’s prayer list.

Comments
This field is for validation purposes and should be left unchanged.
Baptismal Candidate Full Name*
Gender*
Has the child been born yet?
- Yes
- No
Date of Birth:
MM slash DD slash YYYY
City of Birth*
Parent 1 Name*
Parent 2 Name*
Street Address*
City, State, Zip*
Phone Number for Parent 1*
Phone Number for Parent 2*
Email Address for Parent 1*
Email Address for Parent 2*
Sponsor(s) Name(s)*
First Choice for Baptism Date*
MM slash DD slash YYYY

Baptisms are performed on the 2nd, 4th, and 5th weeks of the month during our regular worship times.
Time of Service Preferred*
Second Choice for Baptism Date
MM slash DD slash YYYY

Baptisms are performed on the 2nd, 4th, and 5th weeks of the month during our regular worship times.
Time of Service Preferred
Does Parent 1 have a church membership?*
- Yes
- No
Does Parent 2 have a church membership?*
- Yes
- No
If no, then I am a member of...*

A congregation of the
Evangelical Lutheran
Church in America

Bethel Lutheran Church

312 Wisconsin Avenue
Madison, WI 53703-2108

(608) 257-3577

(608) 257-4044 - FAX

Bethel Horizons

South-Central Synod Wisconsin

Bethel is a Reconciling in Christ congregation