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

Phone 

Father's Legal Name     Religion

Mother's First Name and Maiden Surname     Religion

Church and Place of Marriage

Are you a registered member of St. Augustine Parish?        

If no, please explain reason for requesting Baptism at St. Augustine Church

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