Baptism Registration

The information provided will be used for the Official Church Register and Certificate, so please ensure that all information is accurate (spelling, dates, etc.).
You will receive a confirmation email after this form is submitted.

Sacrament Administered

	OFFICE USE ONLY
Minister & Date	To be filled in by Priest

Child Info

Name of Baptized

First Name*

Middle Name

Last Name*

Date of Birth

Required* //

Place of Birth

Required*

Sex of child?
Required*

	Male
	Female

Previously baptized?
Required*

Has the child been privately baptized?*

	Yes
	No

If YES, when?

Is the child adopted?
Required*

	Yes
	No

Date desired for Baptism?

Baptisms held at 1:30 on Sundays. Date will be confirmed by Priest. //

Parent Info

Father's Full Name

First Name*

Middle Name

Last Name*

Religion of Father?

Mother's MAIDEN Name

First Name*

Last Name*

MAIDEN Name

Religion of Mother?

Parents married?
Required*

	No
	Yes

By a Catholic Priest

If YES, married by a Catholic priest?

	Yes
	No

Address

Street 1*

Street 2

City*

State*

Zip*

Phone

Required* --

E-mail

Godparent Info

Godparents must be practicing Catholics in good standing with the Church. Please obtain a Sponsor Certificate for each Godparent.

Godfather's Name

First Name

Last Name

Is Godfather a Catholic?

	Yes
	No

Godmother's Name

First Name

Last Name

Is Godmother a Catholic?

	Yes
	No

Represented by proxy?

Is either Godparent represented by a proxy?

	Yes
	No

If YES, name of proxy:

Baptism Registration

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