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  • Name of Child (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.
  • Gender Male Female
  • Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Email address REQUIRED Please fill out this field. Please enter valid data.
  • Telephone Number REQUIRED Please fill out this field. Please enter valid data.
  • Place of Birth (city) REQUIRED Please fill out this field. Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Father Please enter valid data.
  • Mother (include maiden name) REQUIRED Please fill out this field. Please enter valid data.
  • Godfather Please enter valid data.
  • Godmother Please enter valid data.
  • Member of the Parish REQUIRED Yes No Please fill out this field.
  • Marriage Witnessed by a Priest REQUIRED Yes No Please fill out this field.
  • Is this your first child baptized at St. Mary of the Lake REQUIRED Yes No Please fill out this field.
  • Date of Baptism (leave blank, to be filled in by Fr. Zipp) Please enter valid data.

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