Infant Baptism Registration Form
Saint Catherine Laboure Parish, Harrisburg, PA
Today's Date
/
Month
/
Day
Year
Date
Family Name
Child's Name
First Name
Middle Name
Last Name
Male
Female
Date of Birth
/
Month
/
Day
Year
Date
City and State of Birth
Adopted?
*
Yes
No
Already privately baptized in a hospital (or elsewhere) for any reason?
*
Yes
No
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Family Information
Father's Name
First Name
Middle Name
Last Name
Religion
Baptized?
Yes
No
Confirmed?
Yes
No
Mother's Name
*
First Name
Middle Name
Maiden
Religion
*
Baptized?
*
Yes
No
Confirmed?
*
Yes
No
Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Phone Number
*
-
Area Code
Phone Number
Secondary Phone Number
-
Area Code
Phone Number
Email
example@example.com
Marital State
*
Married
Divorced
Annulled
Separated
Single
Cohabitating
Date of Marriage
/
Month
/
Day
Year
Date
Church/Place of Marriage
Name of Priest, Deacon, or other Marriage Officiant
Additional Children
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Godparents
There must be at least one Godparent; a child may have both one Godfather and one Godmother. Godparents must be practicing Catholics who are Baptized, Confirmed, at least 16 years old, and living a life of faith in keeping with their role as godparents, which includes following Church law with respect to Holy Marriage.
Godfather's Name
*
Godfather's Parish
*
Godmother's Name
*
Godmother's Parish
*
If either a Godmother or Godfather is lacking, one baptized, non-Catholic Christian may serve as a witness:
Christian Witness Name
*
Current Parish
*
Current Denomination
*
Denomination of Baptism
*
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Special Circumstances
Visiting Clergy Requested
Visiting Clergy Name
Visiting Clergy Diocese
Visiting clergy from other diocese will require a letter of good standing from their own diocese.
Out of Parish Baptism Requested
Parish Name
Parish Address
Godparent(s) Proxy
Proxy Name
Proxy Name
Submit
Should be Empty: