Child'sLegal Name: _________________________________________________________
                                     First                Middle/Saint                           Last
Date of Birth:  Month: ___________ Day: _____________ Year: ____________________
Place of Birth: ______________________________________________________________
                               City                                      State                           Zip Code
Was Child Adopted: Yes____ No____ If Yes, Legal Document# ________________
Date of Baptism:  ____________________ Presider's Name: _____________________
Was Child Baptized Privately:  Yes___ No___ If Yes, where: ___________________
Parish Residing: ___________________________________________________________
Father's Name: ____________________________________________________________
                              First                                  Middle                             Last
Address: __________________________________________________________________
                   Street                                                     City/State/Zip Code
Mother's Name: ___________________________________________________________
                                 First                           Middle/Maiden                     Last
Address: __________________________________________________________________
                    Street                                                    City/State/Zip Code
Telephone:  Home: ______________________  Work: ___________________________
Cell Phones:  Mother: ________________________ Father: ______________________

Religion of Father: ________________________  Mother: ________________________
Confirmed: Yes____ No____                                Confirmed: Yes____ No_____
Marriage Status: Yes___ No___   Priest:  Yes___ No___ Judge/Minister Y__ N__
Church Parish of Marriage: _________________________________________________

Name of Godfather: _________________________________ Religion: ______________
Confirmed: Yes_______ No_______

Name of Godmother: ________________________________ Religion: ______________
Confirmed: Yes_______ No_______

Copy of Birth Certificate Must be attached __________________________________
Date of Seminar: ___________________________________________________________