Certificate of Eligibility

The completed certificate will be mailed to the address of the parishioner. If needed, the certificate can instead be mailed to the church where the Baptism will be held, if that is the case, you will need to provide the pastor’s name, church name, and address below.

"*" indicates required fields

Parishioner Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Email*

Child's Name*

First Last

Date of Baptism*

Name of Pastor

Name of Church where Baptism will be held

Church Address

Street Address Address Line 2 City State ZIP Code

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Name

This field is for validation purposes and should be left unchanged.