Baptism Registration

This form must be completed and returned to St Tom's, to the attention of John Strong at least 1 1/2 weeks before the Baptism for the Baptism to be scheduled.

To be completed by Parish Staff.

Recorded (Parish Use Only) Certificate Sent (Parish Use Only)

Have you ever participated in a Baptism Preparation Class? REQUIRED Yes No Please fill out this field.

If Yes, when and where was the Baptism Preparation Class?

What is the full name of child to be baptized? REQUIRED Please fill out this field. Please enter valid data.

What is the child's date of birth? (Format: Month, Day, Year) REQUIRED Please fill out this field. Please enter valid data.

What is the child's place of birth? (City, State) REQUIRED Please fill out this field. Please enter valid data.

Your 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.

What is the main contact's cell phone number? REQUIRED Please fill out this field. Please enter a phone number.

What is the main contact's email address? REQUIRED Please fill out this field. Please enter an email address.

What is your preferred date of baptism? (after the 11:00 a.m. Mass on the First Sunday of the Month) REQUIRED Please fill out this field. Please enter valid data.

What is the Father's First and Last Name?

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
What is the Religion of the Father? REQUIRED Please fill out this field. Please enter valid data.

What is the Mother's First and Last Name?

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
What is the Mother's Maiden Name? REQUIRED Please fill out this field. Please enter valid data.
What is the Religion of the Mother? REQUIRED Please fill out this field. Please enter valid data.

Were parents married by a Catholic Priest or Deacon? REQUIRED Yes No Please fill out this field.

What parish is your family currently registered? REQUIRED Please fill out this field. Please enter valid data.

What is the Godfather's First and Last Name?

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

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

What is the Godmother's First and Last Name?

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

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

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

If applicable, what is the First and Last Name of the Proxy?

First Name Please enter valid data.

Last Name Please enter valid data.

Was your child privately baptized or adopted? REQUIRED Yes No Please fill out this field.

Signature of Minister after the Baptism Please enter valid data.

Date Please enter a date.