Baptism Intake Form

Name of Child Please enter valid data.

Gender Male Female

Place of Birth Please enter valid data.

Date of Birth Please enter valid data.

Parent Marital Status REQUIRED Please fill out this field.

Wedding Date Please enter valid data.

Married by (if applicable) Priest/Deacon Other

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

Religion of Father REQUIRED Please fill out this field.

If "other", please specify: Please enter valid data.

Name of Child's Mother REQUIRED Please fill out this field. Please enter valid data.

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

Religion of Mother REQUIRED Please fill out this field.

If "other", please specify: Please enter valid data.

Are you parishioners of St. Columbkille? REQUIRED Yes No Please fill out this field.

Please indicate which best describes your situation: REQUIRED This is the 1st child I/we bring to Catholic baptism This is the 2nd child I/we bring to Catholic baptism I/we have had 3 or more children baptized Catholic Please fill out this field.

Was the child privately or previously baptized? REQUIRED Yes No Please fill out this field.

Was the child adopted? REQUIRED Yes No Please fill out this field.

Contact Information

Address 1 REQUIRED Please fill out this field. Please enter valid data.

Address 2 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 REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter valid data.

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

Social Media Release

I/we give permission for photos of our child's Baptism to be shared on St. Columbkille Facebook group and/or website. REQUIRED Yes No Please fill out this field.