First & Middle Name of Child
 Last Name of Child
Date of Birth

 Place of Birth
Name of Father
 Maiden Name of Mother
Parent Contact Name Street Address
City, State, ZIP
 Home Phone
Cell Phone
 Work Phone
E Mail
 Parish of Registration
Preferred Time Saturdays 10ASundays 11:40am Preferred Date
Date Submitted
Submitted by

Copy of Birth Certificate or Hospital Record Required

Email Deacon Steve

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