Baptismal Registration Form

Baptismal Registration Form
Scheduled Baptismal Date

- Month - Day Year
Name of Child
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?
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