Baptism Registration Form

Requested Date of Baptism *

Requested Time: *

Child's First Name: *

Child's Middle Name:

Child's Last Name: *

Child's Date of Birth: *

Child's Age:

Months:

Was the Child Baptized in an Emergency?

No

Yes

If yes please explain:

Father's Full Name: *

Father's Parish *

Parish City & State *

Father's Home Address *

City & State *

Zip Code *

Mother's Full Name: *

Maiden Name: *

Mother's Parish *

Parish City & State *

Mother's Home Address *

City & State *

Zip Code *

One set of godparents or one of each is permitted

Godfather's Parish *

Godfather's Parish City & State *

Godmother's Parish *

Godmother Parish City & State *

Will you need a proxy or proxies? *

Yes

No

Name of Proxy or Proxies

To complete registration, besides this form, you must also turn in the following (2 weeks prior baptism):

Child's Birth Certificate

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