Baptism Request Form
Are you currently a Queen of Heaven Parishioner?
Yes
Yes, but I'm listed under my parents
No, I'd like to join
No, I belong to a different Parish
Other
Father's Full Name
*
First Name
Middle Name
Last Name
Mother's Full Name
*
First Name
Middle Name
Last (MAIDEN) Name
Church of Parent's Marriage
*
Family Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daytime Telephone #
-
Area Code
Phone Number
E-mail
*
Child's Full Name
First Name
Middle Name
Last Name
Date of Birth
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Place of Birth (City and State)
PLEASE PROVIDE COPY OF BIRTH CERTIFICATE AT YOUR EARLIEST CONVENIENCE.
Was child privately Baptized, and if so, where?
Note: This may happen at the hospital of birth if there are complications.
What date were you interested in Baptism?
/
Month
/
Day
Year
2 digit month, 2 digit day, 4 digit year
Our Baptisms are usually scheduled for the third (3rd) Sunday of each month following the 11:15 am Mass which is around 12:15 pm.
God Father's Name
First Name
Last Name
Name of Parish God Father attends
*If not a Queen of Heaven Parishioner, we will need a Letter of Recommendation from their Parish at least ten (10) days prior to the Baptism Date.
God Mother's Name
First Name
Last Name
Name of Parish God Mother attends
*If not a Queen of Heaven Parishioner, we will need a Letter of Recommendation from their Parish at least ten (10) days prior to the Baptism Date.
Have you attended a Baptism Class?
*
Yes
No
Is this your first child being baptized?
*
Yes
No
Submit
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