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Baptism online Registration Form

- Liturgy & Sacraments
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  - Sacraments
    
    Baptism
    
    Baptism Online Registration Form
    
    Reconciliation
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Contact Us
- Deacon Ronald Herr
  
  Baptismal Preparation
  
  (806)- 376 -7204 Ext. 3036
  herrstmarysamarillo.com

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- Child's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Child's Birth REQUIRED Please fill out this field. Please enter valid data.
- Was the child adopted? REQUIRED Yes No Please fill out this field.
- Legal Father's Full Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Father’s email Please enter valid data.
- Religion of Father REQUIRED Please fill out this field. Please enter valid data.
- Legal Mother's full Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother’s email Please enter valid data.
- Religion of Mother REQUIRED Please fill out this field. Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City, State and Zip REQUIRED Please fill out this field. Please enter valid data.
- Are parents married to each other? REQUIRED Please fill out this field. Please enter valid data.
- If yes, are parents married by the Catholic Church REQUIRED Please fill out this field. Please enter valid data.
- What Mass does the household attend? REQUIRED Saturday, 5:30 Sunday, 8:00 Sunday, 9:30 Sunday, 12:00 Please fill out this field.
- Is household current on their Membership/Stewardship card? REQUIRED Please fill out this field. Please enter valid data.
- How long has household been registered members of St. Mary's? REQUIRED Please fill out this field. Please enter valid data.
- If the adult/s seeking Baptism, is/are NOT the child's biological parent/s, what is the guardianship/custody status of the child? REQUIRED Please fill out this field. Please enter valid data.
- Godparent Information:
- Potential Godfather's Name REQUIRED Please fill out this field. Please enter valid data.
- Is Godfather at least 16 years of age, Baptized, Confirmed and a practicing Catholic? REQUIRED Please fill out this field. Please enter valid data.
- If married, is he married in the Church? REQUIRED Please fill out this field. Please enter valid data.
- Is he cohabitating with anyone outside of marriage? Please explain: REQUIRED Please fill out this field. Please enter valid data.
- Is Godfather a parishioner at St. Mary's? If No where? REQUIRED Please fill out this field. Please enter valid data.
- Potential Godmother's Name REQUIRED Please fill out this field. Please enter valid data.
- Is Godmother at least 16 years of age, Baptized, Confirmed and a practicing Catholic? REQUIRED Please fill out this field. Please enter valid data.
- Is she cohabitating with anyone outside of marriage? Please explain: REQUIRED Please fill out this field. Please enter valid data.
- Is Godmother a parishioner at St. Mary's? If No where? REQUIRED Please fill out this field. Please enter valid data.
- If married, is he married in the Church? REQUIRED Please fill out this field. Please enter valid data.
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