Request a Baptism

Desired Date (#1) Please enter a date.

Desired Date (#2) Please enter a date.

Desired Parish St. Mary's St. Helena's

Email Please enter valid data.

Call back number Please enter a phone number.

First, Middle and Last Name of Person to be Baptized Please enter valid data.

Gender Male Female

Date of Birth Please enter a date.

Hospital of Birth Please enter valid data.

Home Address Please enter valid data.

Mailing Address (if different) Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Father's Full Name (First, Middle and Last) Please enter valid data.

Mother's Full Name (First, Middle and Last) Please enter valid data.

Mother's Maiden Name Please enter valid data.

Have you had instruction on the sacrament of baptism from a Catholic priest? Yes No

Godfather's Name Please enter valid data.

Is he a Catholic sponsor or a Christian witness? Catholic sponsor Christian witness

Godmother's Name Please enter valid data.

Is she a Catholic sponsor or a Christian witness? Catholic Sponsor Christian Witness

Notes for the Secretary

St. Mary Catholic Church