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Name (First, Last)

Phone Number

Email Address

Mailing Address (if requesting a mailed certificate)

Certificate for

Sacrament Requested

Full Name at the Time of the Sacrament

Current Legal Name (if different)

Date of Birth

Parent(s)' Names (including mother's maiden name)

Approximate Date of the Sacrament

Any additional information that may help us locate the record.

Purpose of the Request

Father's Email address

Mother's Name (Last, First)

Mother's Maiden Name

Mother's Religion

Mother's Cell Number

Mother's Email address

Number of children in Parish School of Religion

Is Copy of Baptismal Certificate on file with OLPH?

Yes

Grades of Children in Parish School of Religion

Registration Fee ($50.00 for 1st child, $35.50 for any other siblings in 10th grade or below)

Paid by Cash at Church Office

Paid by check at Church Office

Paid On-line with Credit Card

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