Baptism Registration Form

Child's Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Gender Male Female

Place of Birth Please enter valid data.

Home Address 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.

Home Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Cell or Work Phone Number REQUIRED Please fill out this field. Please enter a phone number.

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

Was the child baptized privately in a hospital or elsewhere? Yes No

Birth Father's Name Please enter valid data.

Father's Religion Please enter valid data.

Birth Mother's Name Please enter valid data.

Mother's Religion Please enter valid data.

Married: Yes No

Church Attendance

Location of Marriage Please enter valid data.

Other Children REQUIRED Please fill out this field.
Child 1
- Name Please enter valid data.
- Age Please enter valid data.
Child 2
- Name Please enter valid data.
- Age Please enter valid data.
Child 3
- Name Please enter valid data.
- Age Please enter valid data.
Child 4
- Name Please enter valid data.
- Age Please enter valid data.

Suggested Donation Please enter valid data.

Parish Office Use Only

Date Attended Baptism Prep Class: __________________________

Day/Date of Baptism:_________________________
Time: _________________________
Location: _____________________________
During Mass Y / N
Presider: _____________________________

Recorded in Baptismal Register:
Page ____________
ID# _____________

Baptismal Cert Prepared: Y / N
Copy to Priest/Deacon to contact/follow up: Y / N
Family Registered: Y - ID# __________ / N

Is your family registered with St. Clare of Assisi Parish? REQUIRED Yes No Please fill out this field.