Full name of Child...............................................................................

Date of Birth of Child...........................................................

Preferred date of Baptism...................................................

Name of Father....................................................................................
Baptised?      Confirmed?

Name of Mother....................................................................................
Baptised?      Confirmed?

Address and Post Code...................................................................

Telephone No........................................................

Occupation of Father................................................................

Occupation of Mother................................................................

Names of Godparents( at least three godparents are needed,
two of the same sex as the child, and one  of the opposite sex):

.........................................................  Baptised?  Confirmed?

.........................................................  Baptised?  Confirmed?

.........................................................  Baptised?  Confirmed?

.........................................................  Baptised?  Confirmed?

.........................................................  Baptised?  Confirmed?