Baptism Registration Form

Registered in the parish? Yes No

Date of Registration REQUIRED Please fill out this field. Please enter a date.

Date of Initial Call to the Office REQUIRED Please fill out this field. Please enter a date.

Father's Full Name Please enter valid data.

Father's Religion Please enter valid data.

Mother's Full Maiden Name Please enter valid data.

Mother's Religion Please enter valid data.

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.

Telephone Cell Mother REQUIRED

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

Telephone Cell Father REQUIRED

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

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

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

Have you had children baptized at Saint Theresa in the past? If yes, provide year. Please enter valid data.

Full Name of Child (to be baptized) Please enter valid data.

Child's Date of Birth (to be baptized) REQUIRED Please fill out this field. Please enter a date.

City and State of Birth Please enter valid data.

Sex Male Female

Is this your first child? Yes No

Was Chid Adopted? No Yes

Was the Child privately Baptized? No Yes

Godparents

Office Use Only

Saint Theresa of the Infant Jesus Parish