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Baptism Registration Form

Name of Child*
First Middle Last
*
- Male
- Female
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Phone*
Email*
Child's Date of Birth*
MM slash DD slash YYYY
Place of Birth*
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?*
- Yes
- No
What is the proxy's name?*
First Last
Was the child privately baptized?*
- Yes
- No
Was the child adopted?*
- Yes
- No
Comments
This field is for validation purposes and should be left unchanged.

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