Baptismal Information

Baptismal Information
Child to be Baptized *

First Name Middle Name Last Name
Email Address of Person Submitting Form *
example@example.com
Sex of Child *

Male Female
Child's Date of Birth: *

Month Day Year
Child's Place of Birth: *
City where Born
State *
State where Born
Has the child been previously baptized? *

Yes No
Is the child adopted? *

Yes No
Parents of the Child (as listed on birth certificate or legal custody documents):
Father's Name *

First Name Middle Name Last Name
Religion: *
Father's Religion
Church Attendance: *

Frequently Occasionally Seldom
Parish Where Registered or Church Attending: *
Enter the Church you Attend
Mother's Name *

First Name Middle Name Last Name
Mother's Maiden Name *
Religion: *
Church Attendance: *

Frequently Occasionally Seldom
Parish Where Registered or Church Attending: *
Parents Address *

Parents Address

Street Address Line 2

City State

Zip
Phone Number *

Area Code Phone Number
Are the Parent Married? *

Yes No
Married in the presence of a Catholic priest or deacon? *

Yes No
Date of Baptismal instructions:

Month Day Year
Sponsors of the Child:
Godfather’s name: *
Religion: *
Godmother’s name: *
Religion: *
If either godparent will be represented by proxy, list the proxy below.
Name of Proxy:
Proxy for:
Name of Priest/Deacon Preferred:
Baptismal Date & Time 1st Choice:

Month Day Year
Date Hour Minutes AM/PM Option
Baptismal Date & Time 2nd Choice:

Month Day Year
Date Hour Minutes AM/PM Option
Should be Empty: