Baptismal Information Form

Baptismal Information Form
Requested Date of Baptism*

MonthDayYear
Baptism Date RequestHourMinutesAM/PM Option
Child's Name*

First NameMiddle NameLast Name
Gender*
Date of Birth*

MonthDayYear
Date
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
Date
Please choose one:

Already completedSigned up for upcoming class
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:*

I acknowledge that I have read the above statement and, if applicable, will provide the necessary documentation.
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
DateHourMinutesAM/PM Option
Should be Empty: