BAPTISM RECORD BAPTISM RECORD Please enable JavaScript in your browser to complete this form.Full Name of Child *Date of BirthCity of BirthHome AddressAddress Line 1CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePhoneEmail *Father Name:Religion Mother Name:ReligionMother Maiden Name:Parish Parent(s) are Registered in or attending:If Parent(s) not registered at St Rose of Lima Church, has permission been given from their parish?GODPARENT(S) (Note: we ask that each Godparent fill out and return Baptismal Sponsor Form. Forms are available at the Parish Office)Godfather’s Name:Religion:Godmother’s Name: Religion:Additional Witness:Religion:Proxies (if any)Godfather Proxy:Religion:Godmother Proxy:Religion:OFFICE USE ONLYDate of Baptism:TimePriest/Deacon:Book Number:Page#:Certificate SentEntered in BookVerificationSubmit