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Baptism Registration Form

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  Child's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Middle Name (please enter "none" if applicable) REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Boy Girl Don't Know Yet Please fill out this field.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Child's Birthplace- City REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Birthplace- State REQUIRED Please fill out this field. Please enter valid data.
  
  Child's Date of Birth (or expected) REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred Date of Baptism REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Name (and maiden name) REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Were Parents Married by a Catholic Priest REQUIRED Yes No Please fill out this field.
  
  Are Parents Registered in St. Basil Parish REQUIRED Yes No Please fill out this field.
  
  Godfather's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Godfather's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Godmother's Full Name REQUIRED Please fill out this field. Please enter valid data.
  
  Godmother's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Was Child Baptized Privately REQUIRED Yes No Please fill out this field.
  
  Age of next youngest Child Please enter valid data.
  
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St. Basil the Great Parish

Phoenixville, PA

Baptism Registration Form