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Baptism Form

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  Today's Date (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
  
  Legal FIRST Name of the child you would like baptized REQUIRED Please fill out this field. Please enter valid data.
  
  MIDDLE name of child you would like baptized REQUIRED Please fill out this field. Please enter valid data.
  
  Legal LAST name of the child you would like baptized REQUIRED Please fill out this field. Please enter valid data.
  
  Street REQUIRED Please fill out this field. Please enter valid data.
  
  PO Box, Apartment, etc. 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.
  
  Phone Number (XXX-XXX-XXXX) REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Can this phone number be used for a text message if needed? REQUIRED Yes No Please fill out this field.
  
  Second Phone Number (if needed) Maximum 20 characters Please enter a phone number.
  
  Can this second phone number be used for a text message if needed? Yes No
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Hospital of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  City of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Choose ONE baptism option
  
  Which child is this to be baptized in your family? First Child Second Child Third (or more) Child
  
  Parish you are registered at
  
  Father's LEGAL First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion REQUIRED Please fill out this field.
  
  Mother's LEGAL First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Middle Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Religion REQUIRED Please fill out this field.
  
  Were Parents married by a Catholic Priest? REQUIRED Yes No Please fill out this field.
  
  Godfather's Legal FIRST Name Please enter valid data.
  
  Godfather's Middle Name Please enter valid data.
  
  Godfather's Last Name Please enter valid data.
  
  Is the Godfather a CONFIRMED Catholic?
  
  Godmother's Legal FIRST Name Please enter valid data.
  
  Godmother's Middle Name Please enter valid data.
  
  Godmother's Last Name Please enter valid data.
  
  Is the Godmother a CONFIRMED Catholic?
  
  Was the child privately baptized? (In the hospital, for example) REQUIRED Please fill out this field.
  
  How many people are you expecting to attend? Please enter valid data.
  
  You will be notified either through email, text, or phone call to set up the baptism class you will be a part of. Most baptism classes are usually held the first Tuesday of each month (limit of 3 families per class). If you have not heard back from Cindy or Jim Roberts within 5 days, please call them at 563-870-4428. Please note: Contacting Cindy or Jim through any means other than a phone call may mean that you will not be contacted by them. Thank you!
  
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St. John Baptist de La Salle Pastorate

Holy Cross, IA * 563-870-4041

Baptism Form