Baptism Form - St. Patrick Catholic Church

Requested Baptism Date / Time

Date

Time

Requested Deacon Name *

First

Last

Child to be Baptized *

First

Last

Date of Birth *

City, State of Birth *

Gender

Female
Male

Is the child adopted?

Yes
No

Has the child been previously baptized?

Yes
No

Mother's Name *

First

Last

Mother's Maiden Name

Baptized Catholic *

Yes
No

Confirmed Catholic *

Yes
No

Active / Practicing Catholic *

Yes
No

Mother's Phone *

Father's Name *

First

Last

Baptized Catholic *

Yes
No

Confirmed Catholic *

Yes
No

Active / Practicing Catholic *

Yes
No

Father's Phone *

Family Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Parents Wedding Date *

In Catholic Church *

Yes
No

Parish of Marriage

Address Line 1

Address Line 2

City

State

Zip Code

If parents not married in Catholic Church, do you desire to be?

Parents agree to raise child Catholic, educate as Catholic, and take to Mass on Sundays and Holy Days, etc.? *

Yes
No

Registered Parishioners at St Patrick? *

Yes
No

If not, registered at the following parish: *

Permission to proceed with baptism received *

Yes
No

Godfather's Name *

First

Last

Age *

Is Catholic and meets the following requirements: 1) Must be 16 years of age or older and must have already received all three sacraments of Baptism, Confirmation, and Holy Eucharist. 2) Must be actively practicing their Catholic faith, attending mass on Sundays and Holy Days, living exemplary Christian moral life, mature enough to accept publicly the teaching of the magisterium of the Church, and, if married, must be married in the Catholic Church. If divorced, they cannot have remarried outside of the Catholic Church. If not married, must not be living with significant other. In other words, they must be someone who will be a model for your child in living our Catholic Faith. Also, cannot be a parent of the child to be baptized. 3) One Catholic godparent is sufficient, but, if there are two, there must be one of each gender. *

Yes
No

Is not Catholic, but is an exemplary Christian baptized in another denomination who will serve as a Christian witness. *

Yes
No

Belongs to the following Christian Church: *

Located in (City, State):

If Godfather is represented by a proxy, name of proxy

First

Last

Godmother's Name *

First

Last

Age

Is Catholic, meets requirements 1-3 above.

Yes
No

Is not Catholic, but is an exemplary Christian baptized in another denomination who will serve as a Christian witness. *

Yes
No

Belongs to the following Christian Church: *

Located in (City, State): *

If Godmother is represented by a proxy, name of proxy

First

Last

St Patrick Baptism Form