Baptismal Record

Baptismal Record

St. Mary of the Immaculate Conception
TODAY'S DATE

MonthDayYear
Date
FAMILY NAME (last name)*
PERSON TO BE BAPTIZED (first & middle name)
PERSON'S DATE OF BIRTH

MonthDayYear
Date
PLACE OF BIRTH (city/state)
ADDRESS
CITY, STATE, ZIP
Father's Full Name
First and Last Name
Father's Email Address
example@example.com
Father's cell #
Regarding faith, the father is (check all that apply)*

CatholicConfirmedPracticingNot Catholic
Mother's Full Name*
First and Last Name
Maiden Name
Mother's Email Address*
example@example.com
Mother's cell #*
Regarding faith, the mother is (check all that apply)*

CatholicConfirmedPracticingNot Catholic
Regarding Marital Status:

We are married in the Catholic ChurchWe have NOT been married in the ChurchWe are not married
If married in the Church, at what parish?
By whom?
Name of priest or deacon
Godfather's Name
Regarding faith, the Godfather is

Practicing CatholicConfirmedNot Catholic
Parish Member at
Godmother's Name
Regarding faith, the Godmother is

Practicing CatholicConfirmedNot Catholic
Parish Member at
Has the child been baptized in the case of an emergency?
Do you have a preference as to who performs the baptism?

No preferencePastorDeaconOther
Have you attended a baptism preparation course?
Date of prep class:

MonthDayYear
Date
Location of class:
Should be Empty:

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