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Baptism Registration Form

By Anonymous - Posted on 04 November 2010

Submit this form if you are interested in having your child baptized at St. Basils.

The DRE will contact you within a few days.

Child's Last Name: *

Child's Middle Name:

Child's First Name: *

Gender: *

Boy

Girl

Don't Know Yet

Street Address: *

City/State/ZIP: *

Home Phone Number: *

Email Address: *

Child's Birthplace City/State: *

Child's Date of Birth (or expected): *

Preferred Date of Baptism: *

Father's Full Name: *

Father's Religion: *

Mother's Name (and maiden name): *

Mother's Religion: *

Were Parents Married by a Catholic Priest: *

Yes

If yes to above: where?:

Are Parents Registered in St. Basil Parish: *

Yes

Godfather's Full Name: *

Godfather's Religion: *

Godmother's Full Name: *

Godmother's Religion: *

Was Child Baptized Privately: *

Yes

If yes to above: where?:

Age of next youngest Child:

	Title	Name	Phone	Fax
Contact	CYO President	Gary Duda
Contact	Director of Music	Mary Elizabeth Campbell	484-995-6110
Contact	Director of Religious Education	Erin Gauntner	610-935-1261	610-933-7590
Contact	Gym / Hall Scheduling	Rosalia Provini	610-933-2110	610-933-0627
Contact	Home and School President	Rosemary Burgess
Contact	Parish Office	Maryann Willard	610-933-2110	610-933-0627
Contact	School Office	Jennifer Miller	610-933-2453	610-933-7590
Contact	School Principal	Mrs. Mary Cronin	610-933-2453	610-933-7590
Contact	Youth Ministry Coordinator	Amy Sands	610-935-9354

Baptism Registration Form

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