Baptism Registration form

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Today's Date REQUIRED Please fill out this field. Please enter a date.

Child's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name REQUIRED Please fill out this field. Please enter valid data.
Residence REQUIRED Please fill out this field. Please enter valid data.
Street Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
City of Birth REQUIRED Please fill out this field. Please enter valid data.
Date of Baptism Please enter valid data.

Father's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name REQUIRED Please fill out this field. Please enter valid data.
Religion of Father REQUIRED Please fill out this field. Please enter valid data.

Mother's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name REQUIRED Please fill out this field. Please enter valid data.
Maiden Name Please enter valid data.
Religion of Mother REQUIRED Please fill out this field. Please enter valid data.
Were the parents married by a Catholic priest or deacon? REQUIRED Yes No Please fill out this field.

GODPARENTS INFORMATION

NOTE: Canon law requires that ONE Godparent be a Catholic in good standing. Also, if the Catholic Godparent is not a Catholic Center member, a letter from his or her respective parish stating that he/she is an active member is required.

Godfather's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name Please enter valid data.
Is the Godfather a Catholic? REQUIRED Yes No Please fill out this field.
Is the Godfather a registered member of the Catholic Center? REQUIRED Yes No Please fill out this field.

Godmother's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name Please enter valid data.
Is the Godmother a Catholic? REQUIRED Yes No Please fill out this field.
Is the Godmother a registered member of the Catholic Center? REQUIRED Yes No Please fill out this field.

Is either Godparent represented by a Proxy? REQUIRED Yes No Please fill out this field.

Name of Proxy Please enter valid data.

Other Information

Was the child privately baptized? REQUIRED Yes No Please fill out this field.
Was the child adopted? REQUIRED Yes No Please fill out this field.
Do you wish the child baptized during or after Mass? REQUIRED During Mass After Mass Please fill out this field.
Which Mass? REQUIRED Please fill out this field. Please enter valid data.
How many pews should we reserve? REQUIRED Please fill out this field. Please enter valid data.
It is customary to give the Celebrant an offering for performing the Baptism.

Signature of Celebrant ________________________________