Lumen Christi Baptism Registration

Preferred Baptism Date REQUIRED Please fill out this field.

Alternative Baptism date agreed upon with Lumen Christi staff

Contact Lynn Schelitzche Director of Faith Formation 651-370-1616 [email protected] for assistance

Please enter valid data.

Have you taken a baptism class in the past 3 years? REQUIRED Yes No Please fill out this field.

If no which preparation class will you attend? Please enter valid data.

Child's Full Name (first middle last): REQUIRED Please fill out this field. Please enter valid data.

Please provide a phonetic spelling of name if pronunciation is unclear. Please enter valid data.

Date of Birth: REQUIRED Please fill out this field. Please enter a date.

City of birth: REQUIRED Please fill out this field. Please enter valid data.

Gender of child: REQUIRED Boy Girl Please fill out this field.

Father

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

Last Name REQUIRED Please fill out this field. Please enter valid data.
Catholic? REQUIRED Yes No Please fill out this field.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

Mother

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 REQUIRED Please fill out this field. Please enter valid data.
Catholic? REQUIRED Yes No Please fill out this field.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Members of Lumen Christi: REQUIRED Yes No Please fill out this field.

Permission to announce in bulletin: REQUIRED Yes No Please fill out this field.

Godparents

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

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

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

Number of guests expected at Mass: Please enter valid data.

Comments & Questions: