OFFICE USE ONLY
St. Charles Catholic Church
BAPTISM INFORMATION
Date of baptism: _______/________/_______
(Month) (Day) (Year)
Date registered for baptism class: _______________________
Presider: _____________________________
Which church are you registered at? ____________________________________________________________
Certified copy of birth certificate attached? 
Date planned for baptism: _________/________________________/_________ Mass time: _____________
(Month)
(Day)
(Year)
Full name of child: __________________________________________________________________________
(First)
(Middle)
(Last)
Date of birth: ______________________________________________________________________________
(Month)
(Day)
(Year)
Place of birth: ______________________________________________________________________________
(City)
(State)
(Country)
Father’s name: _____________________________________________________________________________
(First)
(Middle)
(Last)
Mother’s MAIDEN name: ___________________________________________________________________
(First)
(Middle)
(Maiden)
Religion of father: __________________________ Religion of mother: ______________________________
Are the parents married?
YES
NO
In the Catholic church? YES
NO
Present address: ____________________________________________________________________________
(Street)
(City)
(State & Zip)
Phone number: _______________________________ Alternate number: ______________________________
Name of godfather: _________________________________________________________________________
(First)
(Middle)
(Last)
Name of godmother: ________________________________________________________________________
(First)
Godfather
Baptized Catholic?
Confirmed in the Catholic Church?
16 years old or older?
Single?
Married in the Catholic Church?
Regularly attends Sunday Mass?
(Middle)
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO
(Last)
Godmother
Baptized Catholic?
Confirmed in the Catholic Church?
16 years old or older?
Single?
Married in the Catholic Church?
Regularly attends Sunday Mass?
YES
YES
YES
YES
YES
YES
NO
NO
NO
NO
NO
NO