Baptism Registration Form

Please indicate which Parish you are requesting for Baptism Immaculate Heart Our Lady of Perpetual Help

Child to be Baptizted REQUIRED Male Female Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Middle Name Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

City of Birth Please enter valid data.

Father's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Mother's Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Maiden Name Please enter valid data.

Are Child's Parents Married? REQUIRED Yes No Please fill out this field.

Were Parents Married in a Catholic Church? Yes No

Religion REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City and Province Please enter valid data.

Postal Code Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Cell/Work Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Please note this email address will be used for updates to the program and important communications, consider using one that you check often. All communications will come from a Diocese of London email address.

*Godparents must be Baptized and Confirmed Catholic.
If they are not please speak to Christine
or reference this page*

Godparent's Full Name's

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

First Name Please enter valid data.

Last Name Please enter valid data.

Religion Please enter valid data.

Child resides with both parents Yes No

If answer is No, please list which Parent Please enter valid data.

Media Release I UNDERSTAND THAT Our Lady of Perpetual Help Church COLLECTS, RECORDS, PUBLISHES, POSTS, TRANSMITS AND DISPLAYS AUDIO/VISUAL "MEDIA" (IMAGES, RECORDINGS, VIDEOS AND OTHER MEDIA) TO FURTHER THE MINISTRY PURPOSES OF THE CHURCH. THIS APPLIES TO ALL MEDIA DISPLAYED PUBLICLY, ON THE CHURCH WEBSITE, VIA EMAILS OR IN ANY WAY MADE AVAILABLE TO VIEWING OR LISTENING BY THE CHURCH GENERAL PUBLIC. i UNDERSTAND THAT ALL MEDIA REMAINS PROPERTY OF Our Lady of Perpetual Help Church.

I agree REQUIRED Yes No Please fill out this field.

Rose City central Catholic family of parishes

Windsor,Ontario

Baptism Registration Form