St. Therese of Lisieux

102 W. Randolph St., Lansing, MI

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Request for Infant Baptism

Request for Infant Baptism
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  Child's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Child's First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth (City, State) REQUIRED Please fill out this field. Please enter valid data.
  
  Today's Date REQUIRED Please fill out this field. Please enter a date.
  
  Father's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Father's First Name & Middle Initial REQUIRED Please fill out this field. Please enter valid data.
  
  Father's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's First Name & Middle Initial REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Maiden Name REQUIRED Please fill out this field. Please enter valid data.
  
  Mother's Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Home Address (# & Street) Please enter valid data.
  
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  Cell Phone Number Maximum 20 characters Please enter a phone number.
  
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  Were you married by a Catholic Priest or Deacon? Yes No
  
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