Baptism Information form Today's Date * MM DD YYYY Mass Time * Requested date is not guaranteed. After submission, someone from our office will contact you to verify the time and date of your child's baptism. If you have questions, please call the parish office at 620-231-7747 Select one... Sunday - 8:00 am Sunday - 10:00 am Requested Date of Baptism * MM DD YYYY Child's Information Name of Child * First, Middle, and Last Name Birth Date * MM DD YYYY Place of Birth * City State Select One... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Father's Information Father's Name (as listed on Birth Certificate) First Name Last Name Father's Phone (###) ### #### Father's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Father's E-mail Father's Religion Father's Parish where you are a member City State Select one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Language(s) English Spanish Other Mother's Information Mother's Name First Name Last Name Maiden Name Mother's Phone (###) ### #### Address Same as Father? Select one... Yes No Mother's Address Address 1 Address 2 City State/Province Zip/Postal Code Country Mother's Email Mother's Religion Mother's Parish Where you are a member City State Select one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Language(s) Spoken English Spanish Other General Information Are Parents Married? * Yes No If yes, were they married in the Catholic Church * Yes No Various answers to these questions do not prevent one's child from Baptism. Yet, in order to help best foster a Catholic environment of growth, we encourage parents to know that one is unable to receive Confession or Communion while living with a boyfriend/girlfriend. So if this is the case, please see your pastor to talk about being married in the Catholic Church. Was the baby privately baptized? * Yes No Did parent(s) attend a Baptism class? * Yes No When? MM DD YYYY Was the baby adopted? * Yes No Parent(s) pledge to faithfully live the Catholic Faith: Father I/We promise to strive to live the Catholic Faith to the best of my/our ability through family prayer, reception of the Sacraments, and weekly attendance at Holy Mass. I agree Father's Electronic Signature Please type first and last name Today's Date MM DD YYYY Mother I agree Mother's Electronic Signature Please type first and last name. Today's Date MM DD YYYY Godparent (or Sponsor) Information NOTICE! Catholic Church Law (Canons 873 & 893) requires pastors and parents to ensure proper selection of Godparents (or sponsors). So please, only choose Godparents according to these specifications: • They cannot be the parents of the one to be Baptized or Confirmed. • They must be Catholics who have received the Sacrament of Confirmation. • They must be at least 16 years old. • One or two Godparents may be chosen. - If there are two, they must be a male and a female. - They may either be both married to each other or a man from one marriage and woman from another marriage. - If married, they must be married in the Catholic Church (not just civilly). • They must be free from canonical penalty and must lead a life in harmony with the faith in keeping with the function to be undertaken. - They must not be living with a partner romantically outside of marriage. - They should attend Mass regularly and frequently receive the sacraments of Confession and Holy Communion. • A Christian not of the Catholic Faith may be chosen as a witness, but only in conjunction with a Catholic Godparent Godfather Information Godfather's Name First Name Last Name Non-Catholic Christian Witness? Yes No Phone Number (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parish where he is a member City State Select one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Godmother Information Godmother's Name First Name Last Name Non-Catholic Christian Witness? Yes No Phone Number (###) ### #### Address Address 1 Address 2 City State/Province Zip/Postal Code Country Parish where she is a member City State Select one... Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming I affirm and I understand the responsibility of choosing worthy Godparents according to the criteria above. I also understand that I will need to have the Godparent(s) fill out a permission form from their parish if they are members of another parish other than Our Lady of Lourdes, and have them return it at least one week before the Baptism date. I/We Agree * Yes Parent's Signature * Please type first and last name. Parent's Signature Please type first and last name. Date * MM DD YYYY Submission of this form does not constitute a completely scheduled baptism. Thank you for submitting!
