Request Baptism

• Name of the person to be baptized
• First Name: *
• Last Name: *
• Date of Birth: *
• Place of Birth: *
• Gender: MaleFemale
• Home Address:
• City: *
• State:
  —Please choose an option—AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
• Zip:
• Email: *
• Phone: *

• Father's Information

• First Name: *
• Last Name: *
• Religion:
• Occupation:

• Mother's Information

• First Name: *
• Last Name: *
• Religion:
• Occupation:

• General Information

• Are you a registered member of this parish? YesNoI'm not sureNo, but I would like to be
• If no, what is your parish and why are you baptizing your child here?

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