Baptism Registration Form

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Full Name of Child*
First Middle Last
As it appears on birth certificate of child
Birth Date of Child*
Month
Day
Year

Parents are required to provide copy of Birth Certificate of child.
Gender*
- Female
- Male
City/State/Country of Birth*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone*
Email*
Father's Full Name*
First Middle Last
As it appears on birth certificate of child
Religion of Father*
Mother's Full Maiden Name*
First Middle Last
As it appears on birth certificate of child
Religion of Mother*
Marital Status of Parents*
Would you like to arrange a Catholic blessing for your marriage?
Please give Name and City/State/Country of Church
Godfather's Full Name*
First Middle Last
Religion of Godfather
Is Godfather married in the Catholic Church?*
Godmother's Full Name*
First Middle Last
Religion of Godmother
Is Godmother married in the Catholic Church?*
Will either Godparent be represented by a Proxy?*
If Yes, please list name(s) of Proxy*
Was the child adopted?*
Was there a previous emergency Baptism?*
Have parents scheduled or attended a Baptism Preparation Class?
Date of Preparation Class*
Month
Day
Year
Requested Date of Baptism*
Month
Date
Year
Priest or Deacon Requested
Parish Where Family is Registered
Please provide Name, City, & State of other parish*