Requested Date of Baptism

Provide two choices (see Baptism webpage for options).

MM

DD

YYYY

2nd Choice

MM

DD

YYYY

Name of Candidate for Baptism *

Full legal name. If there is a nickname, place in parentheses after first/middle names.

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Gender

Male

Female

Candidate's Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone Number *

Preferred phone number for candidate or parents.

(###)

###

####

Member of St. Peter's

Yes

No

First Parent's Address

If candidate is a child and address is different from candidate.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Member of St. Peter's?

Yes

No

Second Parent's Address

If candidate is a child and address is different from candidate and/or first parent.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country