Baptismal Registration Form
St. Francis de Sales Parish / Divine Infant of Prague
Name of person filling out form:
*
First Name
Middle Name
Last Name
Name of person to be baptized:
*
First Name
Middle Name
Last Name
Was Child Privately Baptized?
*
Please Select
No
Yes
Is Child Adopted?
*
Please Select
No
Yes
Requested Baptism Date
*
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a year
2030
2029
2028
2027
2026
2025
2024
2023
2022
2021
Year
Place of Birth
*
City and State
Date of Birth
*
Gender
*
Please Select
Female
Male
Other
Address
*
Street Address
City
State / Province
Postal / Zip Code
Father's Name
First Name
Last Name
Father's Religion
Please Select
Catholic
Lutheran
Baptist
Presbyterian
Methodist
Other
Father's phone number
Format: (000) 000-0000.
Mother's Name
First Name
Last Name
Mother's Maiden Name
Mother's Religion
Please Select
Catholic
Lutheran
Baptist
Presbyterian
Methodist
Other
Mother's phone number
Format: (000) 000-0000.
Are you currently a member of St. Francis de Sales or Divine Infant of Prague?
*
Yes
No
Marriage Status
Church Marriage
No Married
Marriage Blessed
Other
Godfather's Name
First Name
Last Name
Godfather's Religion
Please Select
Catholic
Lutheran
Baptist
Presbyterian
Methodist
Other
Godfather's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Godmother's Name
First Name
Last Name
Godmother's Religion
Please Select
Catholic
Lutheran
Baptist
Presbyterian
Methodist
Other
Godmother's Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Is Either Godparent Represented by Proxy?
Please Select
No
Yes
Additional Comments
Email
example@example.com
Submit Form
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