Baptism Information & Scheduling

Is this Baptism request for a child or an adult?*

ChildAdult
Select a date for the baptism. If you have previously agreed a date that is not listed here, you can enter that date at the bottom of this page. For more than one child sharing the same date, use that field below when you complete the form for each additional child.
If you have agreed with the baptism coordinator to a date / time for your baptism that was not offered in the above list, please enter it here:
Date / Time Agreed

Child's Name*

First NameMiddle NameLast Name
Child's Gender*

MaleFemale
Please list any siblings:
Father's Full Name

First NameMiddle NameLast Name
Mother's Full Name*

First NameMiddle NameLast Name (Please include mother's maiden name in parenthesis)
Adult's Name*

First NameMiddle NameLast Name
Gender*

MaleFemaleOther

Date of Birth*

MonthDayYear
Date
Place of Birth - City & State*
Please list the names of the Godparent(s) or sponsor(s). For spouses, please list them together on one line. *
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
The email provided is:*

Mom's emailDad's emailBelongs to both parents
Phone Number*
Please enter a valid phone number.
The cell phone provided is:*

Mom's cellDad's cell
Please help us understand your relationship to St. Philip the Deacon:*
If your parents or relatives who attend St. Philip the Deacon, please note them here so that can better understand your connection.
Is there anything you would like us to know?
Should be Empty: