Baptismal Record

Baptismal Record

St. Mary of the Immaculate Conception
TODAY'S DATE

MonthDayYear
Date
FIRST NAME*
of person to be baptized
MIDDLE NAME
LAST NAME*
PERSON TO BE BAPTIZED
BIRTH MONTH*
BIRTH DATE
BIRTH YEAR*
PERSON'S DATE OF BIRTH
CITY OF BIRTH
STATE OF BIRTH
PLACE OF BIRTH
STREET ADDRESS
CITY
STATE
ZIP
HOME ADDRESS
FATHER'S FIRST NAME
LAST NAME
FATHER'S NAME
Father's Email Address
example@example.com
Father's cell #
Regarding faith, the father is (check ALL that apply)*

CatholicConfirmedNot CatholicPracticing
MOTHER'S FIRST NAME*
LAST NAME*
MAIDEN NAME
MOTHER'S FULL NAME
Mother's Email Address*
example@example.com
Mother's cell #*
Regarding faith, the mother is (check ALL that apply)*

CatholicConfirmedNot CatholicPracticing
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
Note: At least one godparent needs to be a confirmed, practicing Roman Catholic.
Godfather's Name*
Regarding faith, the Godfather is [check all that apply]:*

Practicing CatholicConfirmedNot Catholic
Parish Member at
Godmother's Name*
Regarding faith, the Godmother is [check all that apply]:*

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?

PastorNo preferenceDeaconOther
Have you attended a baptism preparation course?
Date of prep class:

MonthDayYear
Location of class:
Should be Empty: