Baptism Registration Form

Name of Child to be Baptized

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

Middle REQUIRED Please fill out this field. Please enter valid data.

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

Date of Birth (Month, Day, Year) REQUIRED Please fill out this field. Please enter a date.

Gender REQUIRED Male Female Please fill out this field.

Birth Place (City, State) REQUIRED Please fill out this field. Please enter valid data.

Father's Name

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

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

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

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

Father's Phone Number (Use dashes, no spaces or parentheses) REQUIRED Please fill out this field. Please enter a phone number.

Address (Number, Street, Apt. #) REQUIRED Please fill out this field. 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.

Mother's Name

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

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

Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.

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

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

Mother's Phone Number (Use dashes, no spaces or parentheses) REQUIRED Please fill out this field. Please enter a phone number.

Address (Number, Street, Apt. #) REQUIRED Please fill out this field. 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.

Are parents married? REQUIRED Yes No Please fill out this field.

Are parents married in the Cathoic Church? REQUIRED Yes No Does not apply Please fill out this field.

Name of church (Write N/A if not married in Catholic Church.) REQUIRED Please fill out this field. Please enter valid data.

City and State of Marriage Please enter valid data.

If NO, we would be happy to help you in reconciling your situation. Would you like a consultation? Yes No Does not apply

Proposed Godfather/Christian Witness

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

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

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

Godfather's Religion REQUIRED Please fill out this field. Please enter valid data.

Over 16? REQUIRED Yes No Please fill out this field.

Catholic Sacraments Received REQUIRED Baptism First Communion Confirmation Catholic Marriage Please fill out this field.

Other Please enter valid data.

Proposed Godmother/Christian Witness

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

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

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

Godmother's Religion REQUIRED Please fill out this field. Please enter valid data.

Over 16? REQUIRED Yes No Please fill out this field.

Catholic Sacraments Received REQUIRED Baptism First Communion Confirmation Catholic Marriage Please fill out this field.

Other Please enter valid data.

Month Baptism Requested REQUIRED Please fill out this field. Please enter a date.

Contact Person REQUIRED Please fill out this field. Please enter valid data.

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

Contact Phone Number (uses dashes, no spaces or parentheses) REQUIRED Please fill out this field. Please enter a phone number.

Parents and Godparents are asked to attend a Baptism Preparation class via ZOOM or in person. You will be contacted by our Baptism coordinator to schedule your class time.