Child's First Name

Child's Middle Name

Child's Last Name

Home Address

Email Address

Phone Number

Child's Date of Birth (mm/dd/yyyy)

Child's Place of Birth

City & State

Is this your first child?

If yes, parents are required to attend a Baptism Prep Class held the first Saturday of every month at 10:00 am in the Parish Hall.

Yes No

Mother's First Name

Mother's Maiden Name

Mother's Religion

Father's First Name

Father's Last Name

Father's Religion

Were parents married by a Catholic priest/deacon?

Yes No

Godmother's Name

Is Godmother a practicing Catholic?

Yes No

Godfather's Name

Is Godfather a practicing Catholic?

Yes No

Will either Godparent be represented by a proxy?

Yes No

Proxy's Name

Was the child privately baptized?

Yes No

Was the child adopted?

Yes No

Have the parents attended a baptismal preparation class?

Yes No

Please provide the date of the Baptism Prep class.

Are the parents registered parishioners of Little Flower Church?

Yes No