Baptism Registration Form

Father's Name

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.
Confirmed? REQUIRED Yes No Please fill out this field.

Mother's Name

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Maiden Name REQUIRED Please fill out this field. Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.
Confirmed? 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.

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

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

Were you married in the Catholic Church by a Priest or Deacon? REQUIRED Yes No Please fill out this field.

If no, where were you married? Please enter valid data.

Are you registered members of this Parish? REQUIRED Yes No Please fill out this field.

Do you attend Mass at our Parish? REQUIRED Yes No Please fill out this field.

If not registered and do not attend here, where do you go to Mass? Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

How often do you attend Mass? REQUIRED Always Frequent Occasional Seldom Never Please fill out this field.

Child's Name

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Place of Birth 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.
Was your child privately baptized in an emergency? Yes No
Was your child adopted? REQUIRED Yes No Please fill out this field.

Concerning Godparents:

You should be aware that at least one Godparent must be a practicing Catholic who has made his/her Confirmation. If two Godparents are chosen, the other must be at least practicing a Christian faith and therin is only witness to the baptism.

If you know the Godparents at this time please enter their information here.

Godfather's Name

First Name Please enter valid data.

Last Name Please enter valid data.
Religion Please enter valid data.
Confirmed? Yes No

Godmother's Name

First Name Please enter valid data.

Last Name Please enter valid data.
Religion Please enter valid data.
Confirmed? Yes No

Will a proxy be present for either Godparent? Yes No

Proxy Name Please enter valid data.

Why are you seeking Catholic baptism for your child? REQUIRED Please fill out this field.

Saints Mary and Joseph Parish

Salem, NH

Baptism Registration Form

Concerning Godparents: