Baptism Registration Form

Today's Date Please enter a date.

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

Are you registered with our parish? REQUIRED Yes No Please fill out this field.

If you are not registered with our parish, which parish are you registered with? Please enter valid data.

CHILD'S INFORMATION

Child's First Name REQUIRED Please fill out this field. Please enter valid data.

Child's Middle Name (indicate n/a if not applicable) REQUIRED Please fill out this field. Please enter valid data.

Child's Last Name REQUIRED Please fill out this field. Please enter valid data.

Child's Suffix (ex. Jr., III) Please enter valid data.

Family Street Address Please enter valid data.

Child's Gender REQUIRED Male Female Please fill out this field.

Child's Birthdate REQUIRED Please fill out this field. Please enter a date.

Child's Birthplace -Hospital 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.

Was the child previously baptized? REQUIRED Yes No Please fill out this field.

If the child was previously baptized, please provide by whom/where/when. Please enter valid data.

Was the child adopted? REQUIRED Yes No Please fill out this field.

If the child was adopted, please provide where/when. Please enter valid data.

FATHER'S INFORMATION

Father's First Name Please enter valid data.

Father's Middle Name Please enter valid data.

Father's Last Name Please enter valid data.

Father's Suffix (ex. Jr., III) Please enter valid data.

Is the father baptized: REQUIRED Yes No Unsure Please fill out this field.

If the father is baptized, where and when (year) was the baptism? Please enter valid data.

If the father is baptized, what is the religion? (ex. Roman Catholic, Byzantine Catholic, Lutheran, etc.) Please enter valid data.

Is there any Eastern Catholic Rite affiliation in the father's family background? REQUIRED Yes No Unsure Please fill out this field.

If the father's family has any Eastern Catholic Rite affiliation, please provide details: Please enter valid data.

MOTHER'S INFORMATION

Mother's First Name Please enter valid data.

Mother's Middle Name Please enter valid data.

Mother's Maiden Name Please enter valid data.

Mother's Last Name Please enter valid data.

Is the mother baptized: REQUIRED Yes No Unsure Please fill out this field.

If the mother is baptized, what is the religion? (ex. Roman Catholic, Byzantine Catholic, Lutheran, etc.) Please enter valid data.

Is there any Eastern Catholic Rite affiliation in the mother's family background? REQUIRED Yes No Unsure Please fill out this field.

If the mother's family has any Eastern Catholic Rite affiliation, please provide details: Please enter valid data.

COUPLE'S MARRIAGE INFORMATION

Date and place of marriage Please enter valid data.

Were you married by a priest or deacon? Yes No

If you weren't married by a priest or deacon, by whom were you married? Please enter valid data.

GODPARENT INFORMATION

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

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

Is he a practicing Catholic? REQUIRED Yes No Unsure Please fill out this field.

If not Catholic, which Christian religion? Please enter valid data.

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

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

Is she a practicing Catholic? REQUIRED Yes No Unsure Please fill out this field.

If not Catholic, which Christian religion? Please enter valid data.

Will either Godparent need a proxy? Yes No Unsure

Name of Godfather proxy, if applicable Please enter valid data.

Name of Godmother proxy, if applicable Please enter valid data.

SCHEDULING PREFERENCE

Preferred date of Baptism Please enter a date.

SAINT JOSEPH CATHOLIC CHURCH

Mechanicsburg, PA

Baptism Registration Form