Baptism Questionnaire

(To be completed by an adult Candidate or by the parents of an infant Candidate)

Child's Name

First Name

Last Name

Child's Date of Birth

MM

DD

YYYY

Child's Place of Birth (City, State, Country)

Father's Name

First Name

Last Name

Father's Religion

Mother's Maiden Name

First Name

Last Name

Mother's Religion

Parent's Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Contact Phone

(###)

###

####

Email

Godfather's Name

First Name

Last Name

Godfather's Religion and Attending Church

Certificate of eligibility must be provided

Godmother's Name

First Name

Last Name

Godmother's Religion and Attending Church

Certificate of eligibility must be provided

Proposed Date for the Baptism

Will be confirmed by the Priest

MM

DD

YYYY

Proposed Time for the Baptism

Will be confirmed by the Priest

General Guidelines

1. Letter of eligibility for each of the Godparents issued by their respective Parish(es). 2. Donation to the Church $100 3. Free Will donation to the Priest

I confirm having read the above guidelines