Request for Baptism - Saint Miriam Parish & School

Request for Baptism

Name of Candidate

Preferred Pronoun

First Name *

Middle Name

Last Name *

Date of Birth *

Place of Birth *

Denomination (if applicable)

Candidate's Gender *

Candidate's Age Range *

Marital Status *

If you were married by a priest from Saint Miriam, could you please enter his name here:

Home Address and Telephone Numbers

Address *

Country

City

State

Zip code

Home Phone *

Work Phone

Mobile Phone

Email *

Mother or First Partner

Name (Mother or Partner 1)

Maiden Name

Preferred Pronoun

Baptised

Yes

Denomination

Father or Second Partner

Name (Father or Partner 2)

Preferred Pronoun

Baptised

Yes

Denomination

Godparent or Sponsor

Name (Godparent or Sponsor)

Preferred Pronoun

Denomination

Address

Apt, suite, etc.

Country

City

State

Zip code

Gender

Male

Female

Godparent or Sponsor

Name (Godparent or Sponsor)

Preferred Pronoun

Denomination

Address

Apt, suite, etc.

Country

City

State

Zip code

Gender

Male

Female

Please note…

There are associated costs for music, staffing, missals and printing, fellowship, janitorial, and supplies, etc., that occur with every event at the parish. As a 100% member-supported parish, we ask that a standardized stipend be applied for such events. Please refer to the fees schedule page for the requested fee for your event. If you cannot afford the standard requested fee, please contact us here and request a hardship scholarship and the fees will be waived. Thank you.

Requested Baptism Date *

Comments/Questions

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