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Baptism & Baptism Class Registration

Name of child to be baptized:

______________________________________________________
(First)

______________________________________________________
(Middle)                 (Last)

Date of Birth _____/_____/_____   Circle one - M / F

Place of Birth _______________________________________

Child lives with: (circle one)

Both Parents    Mom    Dad    Other __________________

Father's Name:

______________________________________________________
(First)          (Middle)          (Last)

______________________________________________________
(Religion)

Mother's Name:

______________________________________________________
(First)          (Middle)          (MAIDEN)

______________________________________________________
(Religion)

Family Information:

______________________________________________________
(Address)

______________________________________________________
(City)                            (State)  (Zip Code)

______________________________________________________
(Phone)

______________________________________________________
(Email *required)

Date of Baptism _____/_____/_____
(confirm after attending baptism class)

______________________________________________________
(Godfather's Name)
* at least one Godparent must be a practicing Catholic and 16 years old

______________________________________________________
(Godmother's Name)
* at least one Godparent must be a practicing Catholic and 16 years old

I/We plan to attend class on _____/_____/_____

First child to be baptized? ______Yes ______ No

Ages of other children _______________________________

St. Gerald Catholic Church - 7859 Lakeview St, Ralston, NE 68127
Phone:(402)331-1955 - Fax:(402)339-8733