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Register for Baptism Form

- SACRAMENTS

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- Name of Child (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter valid data.
- Place of Birth (City and State) REQUIRED Please fill out this field. Please enter valid data.
- Address Please enter valid data.
- Phone Please enter valid data.
- Email REQUIRED Please fill out this field. Please enter an email address.
- DATE OF BAPTISM (After completing this form, please call the Rectory Office at 610-696-3624 to discuss a Baptism date). Please enter valid data.
- Father's Name Please enter valid data.
- Religion of Father Please enter valid data.
- Mother's Name (Include Maiden Name) Please enter valid data.
- Religion of Mother Please enter valid data.
- Were Parents Married By a Catholic Priest? Please enter valid data.
- Name of Godfather Please enter valid data.
- Is Godfather Catholic? Please enter valid data.
- Name of Godmother Please enter valid data.
- Is Godmother Catholic? Please enter valid data.
- Will either Godparent need to be represented by Proxy? Please enter valid data.
- Is this your first child? If so, please call the Rectory Office to register for our next Pre Jordan class which is held on the 4th Sunday of the month from 10:00 AM - 11:00 AM. REQUIRED Please fill out this field. Please enter valid data.
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