Baptism Registration Form Welcome to St. Andrew Roman Catholic Church. Please fill out the Baptism registration form. If you have any questions regarding this form, please call us at 954-752-3950. Thank you! "*" indicates required fields I am completing this registration form*to have my child Baptized at St. Andrew.because I need to complete a Baptismal class to be a Godparent.because I am having my child baptized at another parish and need to complete a Baptismal class.Do you prefer the Baptism in English or Spanish?*EnglishSpanishA baptismal class is required, will you attend the class in English or Spanish?*EnglishSpanishWho will be attending the baptismal class?* Mother Father Godmother Godfather Please mark all that apply.Child's Full Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Child's Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age of Child* Place of Birth: Name of City* Place of Birth: Name of County* Place of Birth: State (Name of country if born outside United States)* Is the child adopted?*YesNoEnvelope # (Registered Parishioners Only)Father's Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Name Middle Name Last Name Suffix Mother's Maiden Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Name Middle Name Maiden Name Suffix Are the Parents Married?YesNoIf Married, where? (Name of Church? City?) If not married by church - please type civilly)Parents Address* Street Address Apartment Number City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Primary Telephone (Parents)*Secondary Telephone (Parents)Parents Email Godfather's InformationGodfather* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix Marital Status*SingleMarriedWidowedDivorcedCommon Law (Living Together)If Married, where? (Name of Church? City? Country?)*Please write N/A if not married. What is the name of the church that the Godfather currently attends?* Envelope Number (St. Andrew Parishioner only)Primary Telephone Number (Godfather)*Secondary Telephone NumberGodmother's InformationGodmother* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Last Suffix What is the name of the church that the Godmother currently attends?* Marital Status*SingleMarriedWidowedDivorcedCommon Law (Living Together)If Married, where? (Name of Church? City? Country?)*Please write N/A if not married. Envelope Number (St. Andrew parishioner only)Primary Telephone (Godmother)*Secondary TelephoneAdditional InformationAre Godparents represented by proxy?*YesNoIf yes, what are the Proxy names?Is Baptism at Saint Andrew?*YesNoIf not, where? (Please give name of church and location) PhoneThis field is for validation purposes and should be left unchanged.