Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Choose One *

Request being made to be a baptismal godparent

Request being made to be a confirmation sponsor

Name of person being baptized/confirmed *

First Name

Last Name

Date of baptism/confirmation *

MM

DD

YYYY

Address of Church where Sacrament will be Held *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

I confirm I am at least 16 years of age *

Yes

No

I attend Mass with my family *

daily

weekly

three times a month

twice a month

once a month

less than once a month