Arrange a Baptism

Baby's First, Middle and Last Name REQUIRED Please fill out this field. Please enter valid data.

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

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

Mother's First and Maiden Name REQUIRED Please fill out this field. Please enter valid data.

Does Mother use maiden name? REQUIRED Yes No Please fill out this field.

Father's First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Are parents married? REQUIRED Yes No Please fill out this field.

Address REQUIRED Please fill out this field. 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.

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

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

Godfather's First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Godmother's First and Last Name REQUIRED Please fill out this field. Please enter valid data.

Are all names provided are spelled correctly. REQUIRED Yes No, I will email Holy Name with the correct spelling. Please fill out this field.

Is your first child to be baptized? REQUIRED Please fill out this field. Please enter valid data.

Do you want your child's name printed in the Parish bulletin? REQUIRED Yes No Please fill out this field.

Questions/Notes