Baptism Registration Form

Date of Baptism REQUIRED Please fill out this field. Please enter a date.

First Name of Child REQUIRED Please fill out this field. Please enter valid data.

Middle Name of Child REQUIRED Please fill out this field. Please enter valid data.

Last name of Child REQUIRED Please fill out this field. Please enter valid data.

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 Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.

Where was the child born? (Please provide the city & state only) REQUIRED Please fill out this field. Please enter valid data.

Was the child adopted? REQUIRED Yes (must show proof of adoption) No Please fill out this field.

Privately baptized (by emergency in a hospital, at home, etc.) REQUIRED Yes* No Please fill out this field.

*If yes,, where and by whom? Please enter valid data.

Father's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last 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 Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

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.

Are the parents married in the Catholic Church? REQUIRED Yes No Please fill out this field.

Do the parents have a civil/secular marriage license? REQUIRED Yes No Please fill out this field.

Are the parents registered members of our parish? REQUIRED Yes No* Please fill out this field.

If you are not registered parishioners, what is your connection to this parish?

Please provide the name of your connection to our parish, or elaborate if you have chosen other.

If you are registerd at another parish, you must get permission from your pastor to have the baptism here. Please call your home parish. If you live in the parish borders, you must be registerd parishioners here.

Is this the first child being baptized? REQUIRED Yes (parents must participate in a class) No Please fill out this field.

Godparent Information

Male Godparent / Witness Name REQUIRED Please fill out this field. Please enter valid data.

Is the Godfather Catholic? REQUIRED Yes No* Please fill out this field.

If no, what faith tradition is the Godfather? Please enter valid data.

What is the Godfather's relationship to the child? REQUIRED Please fill out this field. Please enter valid data.

Female Godparent / Witness Name REQUIRED Please fill out this field. Please enter valid data.

Is the Godmother Catholic? REQUIRED Yes No* Please fill out this field.

If no, what faith tradition is the Godmother? Please enter valid data.

What is the Godmother's relationship to the child? REQUIRED Please fill out this field. Please enter valid data.

Is either Godparent represented by Proxy? REQUIRED Yes* No Please fill out this field.

*If yes, proxy must meet Catholic sponsorship requirements.

Who is the proxy? Please enter valid data.

Guest Clergy

Name Please enter valid data.

Guest clergy MUST provide a Letter of Good Standing from his diocese or religious superior and send to ST. John/St. Charles either by

FAX - 845-855-1273
Email- [email protected]

or post mailed at least two weeks prior to the baptism to:

Father John F. X. Palatucci
39 East Main St.
Pawling, NY 12564

Clergy notes:

St. John the Evangelist (Pawling, NY)
St. Charles Borromeo (Dover Plains, NY)

Baptism Registration Form

Please review the requirements for Godparents
before beginning to complete this form.

Our online registration for Baptism is being updated.
Please call the office or email us for more information.

CONTACT US

Father's Information

Mother's Information

Godparent Information

Guest Clergy

Baptism Registration Form

Please review the requirements for Godparents before beginning to complete this form.

Our online registration for Baptism is being updated. Please call the office or email us for more information.

CONTACT US

Father's Information

Mother's Information

Godparent Information

Guest Clergy

Please review the requirements for Godparents
before beginning to complete this form.

Our online registration for Baptism is being updated.
Please call the office or email us for more information.