Please email the completed form and a copy of the Baptism Certificate* to:

secretary@saintpatrickmystic.org

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Child’s Name: ______________________________________________________________________________

                               First                               Middle                                Last                  

 

______Male        _______Female

 

Date of Birth: ___________________________________

Place of Birth: ___________________________________

Date of Baptism: ________________________________

Church where child was Baptized: ________________________________________*

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What grade is the child in_________________

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Father’s Name ____________________________________________________________

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            Religion: _______________________________________________________

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Mother’s First and Maiden Name: _________________________________________

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           Religion: ________________________________________________________

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Church where parents were married: ______________________________________

 

Residence: ____________________________________________________________

 

Telephone Number: ___________________________   Email: ___________________________________

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*A copy of the child’s Baptism Certificate is required if he/she was not Baptized at

Saint Patrick Church, Mystic