Infant and Young Children Baptism Form

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

Middle Name of the Child Please enter valid data.

Last Name of the Child REQUIRED Please fill out this field. Please enter valid data.

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.

Date of Birth of the Child REQUIRED Please fill out this field. Please enter a date.

Place of Birth of the Child REQUIRED Please fill out this field. Please enter valid data.

Was the Child Adopted REQUIRED Yes No Please fill out this field.

Is the Family Registered at IHM REQUIRED Yes No Please fill out this field.

Class Date REQUIRED Please fill out this field.

Father's Name REQUIRED Please fill out this field. Please enter valid data.

Mother's Full Maiden Name REQUIRED Please fill out this field. Please enter valid data.

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

Secondary Email Please enter an email address.

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

Secondary Phone Number Please enter a phone number.

Godparent Information

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

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

Catholic REQUIRED Yes No Please fill out this field.

First Name Please enter valid data.

Last Name Please enter valid data.

Catholic Yes No

Note: Each child must have at least one Godparent, and no more than two. If there are two, then one must be a man and the other a woman. At least one Godparent must be Catholic, and in good standing with the Church.

Is either Godparent represented by proxy? REQUIRED Yes No Please fill out this field.

If yes, proxy's name Please enter valid data.