Saint Rose of Lima Catholic Church
Application for Baptism

 

Please print this form, fill in all of the requested information, sign it, and include it in the Baptism Application Packet you bring to the St. Rose Parish Office. 

 

Saint Rose of Lima Parish

615 Vine Ave.

Roseville, CA  95678

 

Child Information

Child's Full Name 

 

 

 

                                                         First                                                  Middle                                                  Last    

 

Date of Birth:

 

City of Birth:

 

State of Birth:

 
Parent Information
Father's Full Name:   Catholic __Yes __No
Mothers Maiden Name:   Catholic __Yes __No

  

Married __Yes __No

In Church: 

 

Other:

 

Date: 

      /      /

Where:

 

 

Address:

 

City: 

 

State:  

 

Zip:

 
Phone:    

 

We hereby request the Sacrament of Baptism for our child.  Date:            /               /

      

____________________________________           __________________________________________

Signature of Father                                               Signature of Mother         

Additional Information
Godfather's Name:   

Practicing Catholic __Yes __No
Godmother's Name:   Practicing Catholic __Yes __No

 Dates to be filled in at the St. Rose Office when you submit the Baptism Application Packet.

Class Date:             /           /  Baptism Date:                /           /

 

Note: No Baptisms during Lent.

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