Baptism Registration

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.

Location of Birth (Name of Hospital, City, & state) REQUIRED Please fill out this field. Please enter valid data.

Parental Information: Address REQUIRED Please fill out this field.

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.

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

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Religious Affiliation REQUIRED Catholic Non-Catholic Please fill out this field.

If you checked Non Catholic, please list your denomination. Please enter valid data.

Please describe your Church attendance REQUIRED Weekly Monthly Occasionally Seldom Please fill out this field.

Name of Mother (If married, please list maiden name) REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Religious Affiliation Catholic Non-Catholic

If you checked Non Catholic, please list your denomination. Please enter valid data.

Please describe your Church attendance REQUIRED Weekly Monthly Occasionally Seldom Please fill out this field.

Parental Information: Are you married validly within the Catholic Church REQUIRED Yes No Please fill out this field.

If married: Location of Marriage

Have you participated in a Baptism formation program within the last year? REQUIRED Yes No Please fill out this field.

Name of Godfather (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.

Religion and Church of Registration REQUIRED Please fill out this field. Please enter valid data.

Name of Godmother (First, Middle, Last) REQUIRED Please fill out this field. Please enter valid data.

Religion and Church of Registration REQUIRED Please fill out this field. Please enter valid data.

Name of Proxy for Godfather (First, Middle, Last) Please enter valid data.

Religion and Church of Registration Please enter valid data.

Name of Proxy for Godmother Please enter valid data.

Religion and Church of Registration Please enter valid data.

Are you a member of Immaculate Conception Church? (If no we will need a letter of permission from the pastor of where you are registered before we can schedule the baptism REQUIRED Yes No Please fill out this field.

Baptisms are usually scheduled after the Saturday Evening Mass and the last Mass on Sunday morning. Please offer some dates and times. If the weekend times do not work for your schedule, we can schedule the baptism according to your needs. REQUIRED Please fill out this field.

Immaculate Conception Church of BVM

New Oxford, PA

Baptism Registration

REGISTERING FOR BAPTISM

BAPTISM REGISTRATION FORM