Child’s Name:                                                                                                            

Birthdate:                                                          Place:                                                

Baptismal Date:                                                                                                         

Family Address:                                                                                                         

Telephone:                                                                                                                 

Father’s Name:                                                Birthdate:                                             

Congregation:                                                                                                            

Mother’s Name:                                              Birthdate:                                              

Congregation:                                                                                                            

God Parents:                                                                                                             

(Sponsors)                                                                                                                 

Other Children:                                                Birthdate:                                           

                                                                     Birthdate:                                           

                                                                     Birthdate:                                           

Remarks: