ST. HENRY BAPTISM REGISTRATION FORM 6696 Springboro Pike Dayton, Ohio 45449 (937) 434-9231 Office Hours M-F 9am-4pm Name of Child: Sex of Child: Male Female Address: City, State, Zip: Phone: Date of Birth: E-mail Address: City/State of Birth: Father's Name: Religion of Father: Mother's Full Maiden Name: Religion of Mother: Are Parents Married: Yes No By A Catholic Priest?: Yes No Requested Date of Baptism (We will confirm your date): After Mass: 5:00 p.m. Vigil 12:30 p.m. Sunday During Mass: 5:00 p.m. Vigil 8:00 a.m. 9:30 a.m. 11:00 a.m. 12:30 p.m. Godfather Catholic: Yes No If Catholic, A registered member of St. Henry's? Yes No Godmother Catholic: Yes No If Catholic, A registered member of St. Henry's? Yes No Is either godparent represented by proxy?: Yes No If yes, Name of Proxy: Was the child privately baptized?: Yes No Has either parent participated in a pre-baptism class in the past 5 years? Yes No If yes, when? At which church?
ST. HENRY BAPTISM REGISTRATION FORM 6696 Springboro Pike Dayton, Ohio 45449 (937) 434-9231 Office Hours M-F 9am-4pm
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