Route 20 Catholic Baptism Intake Form
Please fill out this form and click submit.
PARISH LOCATION
*
Please select all that apply.
St. Bernard's/Waterville
St. Joan of Arc/Morrisville
St. Joseph's/Oriskany Falls
St. Mary's/Hamilton
Candidate Information
Name
*
Date of Birth
*
Place of Birth
Age
Please select one option.
0-8 (Infant)
8-17 (Child)
Adult (18+)
Gender
Please select one option.
Male
Female
Select Option
Male
Female
Is this the firstborn? If yes,
Is the child adopted?
Please select one option.
Yes
No
Parents' Information
Mother ' s name (include maiden name)
Religion of mother
Father's name
Religion of Father
Current Address
*
--
AA
AB
AE
AK
AL
AP
AR
AS
AZ
BC
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NT
NU
NV
NY
OH
OK
ON
OR
PA
PE
PR
PW
QC
RI
SC
SD
SK
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
YT
Phone landline
Phone cell
Email
This address will receive a confirmation email
Were the parents married by a Catholic priest?
Please select one option.
Yes
No
Godparents' Information
Godmother's name
Religion of godmother
Godfather's name
Religion of godfather
Will either godparent be represented by a proxy? (If they are unable to attend, for example).
Please select one option.
Yes
No
Unsure
If yes, what is/are the proxie(s') name(s):
RCIA
Is this an RCIA candidate?
Please select one option.
Yes
No
Other Sacraments to be Received That Day
Please select one option.
1st Communion, Confirmation
1st Communion
Confirmation
Scheduling Preferences
Location
Please select one option.
St. Bernard's Waterville
St. Joseph's Oriskany Falls
St. Joan of Arc's Morrisville
St. Mary's Hamilton
Other
Select Option
St. Bernard's Waterville
St. Joseph's Oriskany Falls
St. Joan of Arc's Morrisville
St. Mary's Hamilton
Other
Time:
*
Requested Clergy
Please select one option.
Rev. Jason C. Hage
Dc. Paul Lehmann
Dc. Mark Shiner
Other
Rev. John P. Donovan
Select Option
Rev. Jason C. Hage
Dc. Paul Lehmann
Dc. Mark Shiner
Other
Rev. John P. Donovan
Confirmed Clergy Presiding
Please select one option.
Rev. Jason C. Hage
Dc. Paul Lehmann
Dc. Mark Shiner
Other
Rev. John P. Donovan
Select Option
Rev. Jason C. Hage
Dc. Paul Lehmann
Dc. Mark Shiner
Other
Rev. John P. Donovan
Requested Date #1
*
Requested Date #2
Confirmed Date
Reception in Parish Hall
*
Please select all that apply.
Yes
No
Special Event Insurance $133.00
*
Please select all that apply.
Pending
Complete
Date #2
Date #3
Notes
Submit
Description
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