St. Mary’s School of Piscataway
13401 Piscataway Road
Clinton, MD 20735
Phone: (301) 292-0527 Fax: (301) 292-8786
e-mail:
parish@stmaryspiscataway.org
Website: http://www.stmaryspiscataway.org
DATA FOR BAPTISMAL REGISTER
Please print and fill out all information
Name of person to be baptized:
________________ _______ __________________
First
Middle Last
Date of Birth: ____________ Hospital & City & State of
Birth: __________________
Current Address of person to be baptized:
____________________________________
City, State, Zip Code:
_________________ _______________ ________________
Name of father:
____________________ _______ __________________________
First
Middle Last
Religion of father:
_______________________________________________________
Phone number: (Home) _____________________ (Work)
_______________________
Maiden name of mother:
__________________ _______ _____________________
First
Middle
Last
Religion of mother:
______________________________________________________
Phone number: (Home) ______________________ (Work)
______________________
Were parents married by a Catholic priest/deacon?
_____________________________
Is father a registered parishioner? ______________ Mother?
_____________________
Name of godfather:
______________________________________________________
Religion of godfather: ________________Godfather represented
by proxy? ___________
Name of godmother:
______________________________________________________
Religion of godmother: _______________Godmother represented by
proxy? __________
Dates parents attended preparation class:
_____________________________________
Dates godparents attended preparation class:
__________________________________
Date of Baptism: ____________ ______ ___________
Month Day Year
Was a baptism performed in an emergency situation?
___________________________
Name of priest/deacon:
__________________________________________________
Remarks:
_____________________________________________________________
Please call the church if you are unable to come to the baptism that you have scheduled.