The Church of St - DOC

							The Church of St. Francis Xavier
55 West 15th Street   Phone: 212-627-2100 x 208
New York, NY 10011            pfink@sfxavier.org
Baptismal Information

Child’s Name ____________________________________________________________
                   Family Name                 First Name                 Middle Name

Date of Birth __________________________ Place of Birth ______________________


Father’s Name ____________________________________________________________
                   Family Name                 First Name                 Middle Name

Mother’s Name ___________________________________________________________
                   Maiden Name                 First Name                 Middle Name

Address _________________________________________________________________


       _________________________________________________________________
                   City                State                    Zip

Telephone _____________________________        ______________________________
                   Home                                         Daytime

E-mail _________________________________


God-parent’s name ________________________________________________________

Religion _________________________ Church ________________________________

God-parent’s name ________________________________________________________

Religion _________________________ Church ________________________________


Date of Baptism __________________________________          Time: _________________


Presider if other than SFX priest ______________________________________________