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  • Full Name of Child REQUIRED Please fill out this field. Please enter valid data.
  • Gender REQUIRED Male Female Please fill out this field.
  • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Place of Birth 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 Full Name REQUIRED Please fill out this field. Please enter valid data.
  • Mother's 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.
  • Mailing Address REQUIRED Please fill out this field. Please enter valid data.
  • Phone Number REQUIRED Please fill out this field. Please enter valid data.
  • Email REQUIRED Please fill out this field. Please enter valid data.
  • Parent's Marital Status REQUIRED Single Married in the Catholic Church Married Civil Separated Divorced Please fill out this field.
  • Are you registered parishioners of Holy Name REQUIRED Yes No Please fill out this field.
  • Is the child adopted REQUIRED Yes No Please fill out this field.
  • Other children's names and ages REQUIRED Please fill out this field. Please enter valid data.
  • Godfather's Name, Religion, and home parish (if not registered parishioner at Holy Name, he will need a letter of good standing from his parish) REQUIRED Please fill out this field.
  • Godmother's Name, Religion, and home parish (if not registered parishioner at Holy Name, she will need a letter of good standing from her parish) REQUIRED Please fill out this field.
  • Will either godparent be represent by a proxy? REQUIRED Yes No Please fill out this field.
  • Name(s) of proxy Please enter valid data.
  • Any questions or comments? Please enter valid data.

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