BAPTISM RECORD

Full Name of Child *

Date of Birth

City of Birth

Home Address

Address Line 1

City

State

Zip Code

Phone

Email *

Father Name:

Religion

Mother Name:

Religion

Mother 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?

Forms are available at the Parish Office)

Godfather’s Name:

Religion:

Godmother’s Name:

Religion:

Additional Witness:

Religion:

Godfather Proxy:

Religion:

Godmother Proxy:

Religion:

Date of Baptism:

Time

Priest/Deacon:

Book Number:

Page#: