(337) 235-4618 | 818 12TH St., Lafayette La, 70501

Immaculate Heart Of Marry Catholic Church

Immaculate Heart of Mary Catholic Church Baptism Form

For Office Use Only

Presiding priest/deacon:
Date of Baptism:
Entered. in Sac. reg. & computer by:
Date:
Cert. Mailed: Date
Baptismal Fees Paid:
YesNo
Today's Date
Child's Name First:
Last:
Date of Birth
City and state of Birth
Gender of child M/F
Was the child adopted?
YesNo
(If so, legal documentation is needed.)
Are you a legal guardian
YesNo
(If so, legal documentation is needed.)
Father's Name:
Phone number:
Email:
Address:
City
State
Zip
Confirmed?
YesNo
Attended: Workshop:
YesNo
Mother's maiden name:
(A copy of Child's Birth Certificate must be provided if mother is not married)
Phone number:
Email:
Address:
City
State
Zip
Religion of Mother
Mother Confirmed?
YesNo
Att. Workshop:
YesNo
Are you (Parents) registered members of Immaculate Heart?
YesNo
If You are not a member of Immaculate Heart, permission is required from your Parish.
Marital Status of Parents (married, single or divorce, co-habit)
Catholic Church marriage
YesNo
If yes, please provide name of Church, City
Godfather:
Godparent form Returned:
YesNo
Godmother:
Godparent form Returned:
YesNo
Signature of Father

Signature of Mother