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.

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

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

Catholic? REQUIRED Yes No Please fill out this field.

Name of 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.

Catholic? 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.

Godparents/Christian Witness Information

Name of Catholic Godfather Please enter valid data.

Church Where Godfather was Baptized Please enter valid data.

Name of Catholic Godmother Please enter valid data.

Church Where Godmother was Baptized Please enter valid data.

Name of non-Catholic Christian Witness (in the case of having only one Godparent) Please enter valid data.

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.