Child Record Form

Complete this form when creating a record for a child under the age of eight. The clerk
should enter this information into Leader and Clerk Resources. If the child was blessed, print
a blessing certificate and give it to the child’s parents. Keep the form on file until after the
next membership audit.

Individual Information
Child’s name (surname[s], given name[s], suffix) Gender
Santos, Lucas Furtado dos Male
Birth date Place of birth Born in covenant
20 Jul 2021 Torres, Brazil No
Address
R. José Bonifácio, 430, Centro, Torres, Rio Grande do Sul 95560-000

Parents
Father’s name Member Record number or birth date
Marcio Paulo dos Santos No 25 Feb 1982
Mother’s maiden name Member Record number or birth date
Flavia Furtado Pereira dos Santos Yes 010-0021-5796
Ward or branch where parents live (if other than unit completing form) Unit number (if known)

Name of person the child lives with (if other than parents) Member Record number or birth date
 Yes  No

Blessing Information
Blessing date

Name of person who performed the blessing Priesthood office Record number or birth date

Ward or branch Stake or district

Ramo Torres (Rs) (323314) Distrito Osório Brasil (616982)
For details on how your personal data is processed, please go to www.churchofjesuschrist.org and click the Privacy Notice link at the bottom of the page, or you may
request a copy.

Signature of parent or legal guardian Date