Baptism Registration Form

Name of Child*

First Middle Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Child's Date of Birth*

Place of Birth*

Is this your first child?*

Mother's Name*

First Maiden Name

Mother's Religion*

Father's Name*

First Last

Father's Religion*

Church of Marriage

Godfather's Name*

First Last

Godfather's Religion*

Godmother's Name*

First Last

Godmother's Religion*

Will either Godparent be represented by proxy?*

What is the proxy's name?*

First Last

Was the child privately baptized?*

Was the child adopted?*

Email

This field is for validation purposes and should be left unchanged.

Our Lady of Victory Parish Floral Park, NY