(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