Baptismal Registration Form

Baptismal Registration Form
Scheduled Baptismal Date

- Month - Day Year
Name of Child *
First / Middle / Last
Birth Date *

- Month - Day Year
Place of Birth *
City of Birth *
State of Birth *
Mother's Name *

First Name Last Name
Mother's Maiden Name *
Mother's Religion *
Father's Name *

First Name Last Name
Father's Religion *

Address *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number *

- Area Code Phone Number
E-mail *
Are parents married? *
If yes, were parents married by a Catholic priest or deacon? *
Godfather Name *
Is Godfather a Catholic? *
Godmother Name *
Is Godmother a Catholic? *
Is either Godparent represented by a Proxy? *
If yes, name of Proxy
Was the child privately baptized? *
Enter the message as it's shown *
Should be Empty: