Sacrament of Baptism -- Appendix I

INFORMATION FORM (Please Print)

Father's Full Name: _________________________________________________

Is Dad Catholic? _______(y/n) if not what religion? ________________________

Was Baptized? ________(y/n) Was Confirmed? ___________________________

Mother's Full Name (include Maiden Name):_______________________________

Is Mom Catholic? _______(y/n) if not what religion? ________________________

Was Baptized? ________(y/n) Was Confirmed? ____________________________

Family Address: ____________________________________________________

City ____________________ State __________ Zip __________

Family Telephone: _________________

Are you a member of St. Clement of Rome Parish? ________ (y/n)

Do you receive the church Bulletin? _________(y/n)

Do you receive the church envelopes? _________(y/n) & Envelope # ______

Place where Married:_________________ Name of Celebrant:_________

If not Married in Catholic Church give reason: --Use back of Page-Do no use great detail.

Full Name of Child: ___________________________

Birthday:___________ City and State of Birth:____________________

First and Last Name of Godfather:________________________

Godfather's religion: _________ Church Attends ________ Is Practicing Catholic: ___ (y/n)

First and Last Name of Godmother:________________________

Godmother's religion: _________ Church Attends: _______ Is Practicing Catholic: ___ (y/n)

When are you expecting to baptize your child? Give Month and Year:___________

Do you have other children: If yes list their first name and their age:

_____________________        ___________________

_____________________        ___________________