Baptism Request Form

Registered in this parish? REQUIRED Yes No Please fill out this field.

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Home Address

Address REQUIRED Please fill out this field. Please enter valid data.
Address Line 2 Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Parents' Information

Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.
Mother's Full Name REQUIRED Please fill out this field. Please enter valid data.
Religious Affiliation REQUIRED Please fill out this field. Please enter valid data.
Marital Status REQUIRED Please fill out this field.
Place of Marriage Please enter valid data.
Date of Marriage REQUIRED Please fill out this field. Please enter a date.

Primary Phone Type REQUIRED Please fill out this field.

Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Secondary Phone Type REQUIRED Please fill out this field.

Secondary Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Child

First Please enter valid data.
Middle Please enter valid data.
Last Please enter valid data.
Birthdate REQUIRED Please fill out this field. Please enter a date.
Place of Birth REQUIRED Please fill out this field. Please enter valid data.
Gender Female Male
Baptismal Date Requested REQUIRED Please fill out this field. Please enter a date.

Godparents

At least one Godparent must be Catholic and have received the Sacrament of Confirmation.

Godfather Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Is Godfather a confirmed Catholic? REQUIRED Yes No Please fill out this field.
Religious Affiliation Please enter valid data.

Godmother Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Is Godfather a confirmed Catholic? REQUIRED Yes No Please fill out this field.
Religious Affiliation Please enter valid data.

Godparent Proxy

Baptismal Preparation

Second Date of Class Chosen Please enter valid data.
Please explain if unable to attend a class or if you previously attend one for an older child's baptism. Please enter valid data.
I, as the parent/guardian, acknowledge that this information will be submitted to the parish for use in registration if applicable.
Parental Confirmation Please select this field.