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Please fill in as much as you can so we can process your request promptly.

GENERAL INFORMATION

(fill in all sections)
Home Phone Number *
Work Phone Number *
Registered with Holy Catholic Community? *
 yes 
 no 
Name of person to be Baptized *
Prefix
First *
Last *
Suffix
Middle name (if required)
Date of Birth *

MM		/
DD		/
YYYY
Place of Birth *
Street Address *
Address Line 2
City *
State / Province / Region *
Postal / Zip Code *
Country *

Parent's Information

(fill in all sections)
Father's Name *
Prefix
First *
Last *
Suffix
Middle Name (optional)
Rite of Father *
 Roman Catholic (Confirmed) 
 Eastern Orthodox (Confirmed) 
 Protestant 
 Other *describe below* 
*other*
Mother's Maiden Name *
Prefix
First *
Last *
Suffix
Middle Name (optional)
Rite of Mother *
 Roman Catholic (Confirmed) 
 Eastern Orthodox (Confirmed) 
 Protestant 
 Other *describe below* 
*other*

GODPARENT'S INFORMATION

At least one Godparent must be Confirmed Catholic
Godfather's Name *
Prefix
First *
Last *
Suffix
Middle Name (optional)
Rite of Godfather *
 Roman Catholic (Confirmed) 
 Eastern Orthodox (Confirmed) 
 Protestant 
 Other *describe below* 
*other*
Parishioner of what Church?
Godmother's Maiden Name *
Prefix
First *
Last *
Suffix
Middle Name (optional)
Rite of Godmother *
 Roman Catholic (Confirmed) 
 Eastern Orthodox (Confirmed) 
 Protestant 
 Other *describe below* 
*other*
Parishioner of what Church?

PROXY GODPARENT'S INFORMATION

At least one Proxy Godparent must be Confirmed Catholic
Proxy Godfather's Name
Prefix
First
Last
Suffix
Middle Name (optional)
Rite of Proxy Godfather
 Roman Catholic (Confirmed) 
 Eastern Orthodox (Confirmed) 
 Protestant 
 Other *describe below* 
*other*
Parishioner of what Church?
Proxy Godmother's Maiden Name
Prefix
First
Last
Suffix
Middle Name (optional)
Rite of Proxy Godmother *
 Roman Catholic (Confirmed) 
 Eastern Orthodox (Confirmed) 
 Protestant 
 Other *describe below* 
*other*
Parishioner of what Church?

GENERAL QUESTIONS FOR THE PARENTS

A description of the section goes here.
Are parents of the child married in the church? *
 yes 
 no 
Is at least on of the Godparents Catholic? *
 yes 
 no 
Do you attend mass regularly? *
 yes 
 no 
If yes, what mass time do you attend? (check all that apply)
 0830 
 1230 
 1700 
Do you have any children previously baptized? *
 yes 
 no 
If yes, what date were they baptized?

MM		/
DD		/
YYYY

LETTER OF GOOD STANDING

If you are baptizing your child in another parish or will be a Godparent in another parish, please fill in the information below.
Name of the church
Address of the Church
Street Address
Address Line 2
City
State / Province / Region
Postal / Zip Code
Country
Priests Name
Prefix
First
Last
Suffix
What is the letter for? (check all that apply)
 Baptizing child in States 
 Godparents for a child in another parish 
 Letter of good standing in the Church 
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