Baptismal Information Form

Baptismal Information Form
Requested Date of Baptism

MonthDayYear
2 digit month, 2 digit day, 4 digit yearBaptism Date RequestHourMinutesAM/PM Option
Child's Name

First NameMiddle NameLast Name
Gender
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Place of Birth
Father's Name

First NameMiddle NameLast Name
Father's Religion
Mother's Name - Middle Name Given at Birth; Required for Baptismal Certificate

First NameMiddle NameLast Name
Mother's Maiden Name
Mother's Religion
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email
example@example.com
Name of Parish in which you are currently registered.
Location of parish:
Baptismal Preparation Session Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Please choose one:
If Baptismal Preparation took place at another Parish, please list that here:
Location of Parish:
It is required to have at least one of the godparents to be an active and practicing Catholic member of a parish. If the godfather and/or the godmother are not members of St. Leo's Parish, they must obtain a letter or statement from their Catholic pastor before the Baptism, stating that he and/or she are qualified to act in this capacity. This letter needs to be sent to the St. Leo Parish Office at 335 Springdale Avenue, Winston Salem, NC 27104. The other godparent may be another Catholic or a Christian witness.
By clicking here:
Godfather's Full Name:

First NameMiddle NameLast Name
Please Choose Appropriate Option:
Godmother's Full Name:

First NameMiddle NameLast Name
Please Choose Appropriate Option:
If applicable, please list name(s) of Proxi(es):
Proxi Name:

First NameLast Name
Proxi Name:

First NameLast Name
For Office Use Only
Celebrant Signature
Date Completing this Form:

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDateHourMinutesAM/PM Option
Should be Empty: