Baptism Information Form

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Are you registered parishioners? REQUIRED Yes No Please fill out this field.

Address REQUIRED Please fill out this field. Please enter valid data.

Address Line 2 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.

Email REQUIRED Please fill out this field. Please enter an email address.

Home Phone REQUIRED Please fill out this field. Please enter valid data.

Check if home phone is unlisted. Please select this field.

Mom Cell Phone REQUIRED

Please fill out this field. Please enter a phone number.

Dad Cell Phone

Please enter a phone number.

Child's Full Name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.

Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.

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.

Child is our REQUIRED Please fill out this field.

Is the child a student at Sacred Hearts School or Early Childhood Center? REQUIRED Yes No Please fill out this field.

Is the student part of our RCIC program? REQUIRED Yes No Please fill out this field.

Mother's Full Name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.

Mother's maiden name (if different from above) REQUIRED Please fill out this field. Please enter valid data.

Mother's Religion REQUIRED Please fill out this field. Please enter valid data.

Father's Full Name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.

Father's Religion REQUIRED Please fill out this field. Please enter valid data.

Marital Status REQUIRED Please fill out this field.

For married couples, were you married by a: REQUIRED Please fill out this field.

For married couples, date and place of marriage REQUIRED Please fill out this field. Please enter valid data.

Godmother's full name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.

Godmother's Religion (please note: at least one of the Godparents must be a confirmed Catholic who practices the faith. In addition to this, a baptized non-Catholic Christian may serve as a Christian witness.) REQUIRED Please fill out this field. Please enter valid data.

Is godmother a CONFIRMED Catholic? At which parish was she confirmed? REQUIRED Please fill out this field.

Godfather's full name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.

Godfather's Religion (please note: at least one of the Godparents must be a confirmed Catholic who practices the faith. In addition to this, a baptized non-Catholic Christian may serve as a Christian witness.) REQUIRED Please fill out this field. Please enter valid data.

Is godfather a CONFIRMED Catholic? At what parish was he confirmed? REQUIRED Please fill out this field. Please enter valid data.

Are there any special circumstances (e.g. child was already baptized in an emergency, child is adopted, godparent will be represented by a proxy)?

Please tell us about your and your child's baptism preparation (please check all that apply); Parents have attended the one-hour baptism instruction class at Sacred Hearts within the last 3 years. Parent will plan to take the one-hour baptism prep class prior to the child's baptism Child has attended RCIC (not applicable for infants) Child is planning to attend RCIC (not applicable for infants) Other

Do you have a requested date for the baptism? (Baptisms are typically, but not always, the first and third Sundays of the month at 1pm) Please enter valid data.