Baptism Application Form Please fill out this form in order to apply for a baptism at The Basilica of St Mary Star of the Sea. Child Information/Información del niño/niñaName of Child/Nombre del Niño/Niña(Required) First Last Date of Birth/Fecha de nacimiento(Required) MM slash DD slash YYYY Place of Birth/Ciudad y estado de nacimiento(Required)City, State (*Please bring birth certificate) Child's Address/Direccion del Niño/Niña(Required) Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Preferred Date of Baptism/Fecha preferida de bautizo(Required) MM slash DD slash YYYY Preferred Language/Idioma preferido para el bautizo(Required) Is child adopted/Es adoptado?(Required) Yes No Was the child privately baptized/El niño/niña ha sido bautizado privadamente?(Required) Yes No Parental Information/Información de padresFather's Name/Nombre del padre(Required) First Last Mother's Maiden Name/Nombre de soltera(Required) First Last Parental Contact Email/Correo Electronico(Required) Enter Email Confirm Email Parental Contact Phone/Numero de telefono(Required)Best Time To Call You/Mejor hora para contactarlo?When is the best time for us to reach you via telephone?Mornings/MañanasEarly Afternoon/Medio diaLate Afternoon/Por la tardeEarly Evening/Por la nocheFather's Religion/Religion del padre Mother's Religion/Religion de la madre Are the parents married/Estan casado los padres?(Required) Yes No Were the parents married by a Roman Catholic Priest/Los padres fueron casado por un sacerdote Catolico?(Required) Yes No What Catholic Church do you attend/Cual es su paroquia?(Required) Godparent Information/Información de los padrinosGodfather's Name/Nombre del pardino First Last Godfather's Religion/Religion del padrino Godmother's Name/Nombre de la madrina First Last Godmother's Religion/Religion de la madrina Is either godparent represented by proxy/Alguno de los padrinos está representado por apoderado?If yes, please provide the name of the proxy. Yes No Name of proxy/Nombre del apoderado First Last Any additional information/información adicionalEmailThis field is for validation purposes and should be left unchanged. Δ