Baptism Request

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Today's Date *

Requested Date and Time of Baptism *

Date

Time

Ordained Minister Requested *

Explain if "Other" Minister was selected above

Have you attended a baptismal preparation class for this child or an older sibling? *

Father's Name

Father's Phone Number

Father's Religion

Mother's Name

First, Middle, Maiden and Last Name

Mother's Religion

Mother's Phone Number

Permanent Address *

Address Line 1

Address Line 2

City

State

Zip Code

Home Phone Number

Name of Church Parish you belong to

Registered and attending services

Were parents married by a Catholic priest? *

Child's Full Name

First

Last

Child's Date of Birth *

Child's Place of Birth *

Godfather's Name

Godfather's Religion

Godmother's Name

Godmother's Religion

Is the child adopted? *

Our Mission is to know Christ Jesus.
We are Family, and this is My Home.