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Baptism & Baptism Class Registration

Name of child to be baptized:                         

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(First)                                               

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(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)                                             

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(City)                            (State)  (Zip Code) 

______________________________________________________
(Phone)                                               

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(Email *required)                                     

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

______________________________________________________
(Godfather's Name)               (Catholic? Yes / No) 

______________________________________________________
(Godmother's Name)               (Catholic? Yes / No) 

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