Route 20 Catholic Baptism Intake Form 2021-2024

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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

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

*

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

Time:

*

Requested Clergy

Please select one 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

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

Description

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