Before Baptism, please fill out this form online, print it out and bring it or mail it to St. Augustine Church, 35 Essex St., Andover, MA 01810.

Name of Child 

                        First                        Middle                            Last

Date of Birth       Place of Birth     Parents are required to present copy of Birth Certificate

Home Address

                         Street Address/Apt. No. City/Town Zip

Home Telephone

Father's Legal Name     Religion

Mother's First Name and Maiden Surname     Religion

Church and Place of Marriage

Was the Child Privately Baptized?  Yes   No Was the Child Adopted?  Yes  No

(A special authorization needed for Baptism of an adopted child)

Please refer to our web site on choosing Godparents.   If one is to be a Christian witness, indicate precisely to which denomination he or she belongs.

Godfather's Legal Name           Religion   

Godmother's Legal Name         Religion   

Is either Godparent represented by proxy? Yes  No        If so, which one?   

Name of Person Who Filled Out This Form

Date of Preparation Class     Date of Baptism 

Parents are required to fulfill the Parish program concerning preparation for Baptism

Remarks:

Name of Priest _________________________________________________________________