Child's Full Name

Child's Date of Birth [MM/DD/YYYY]

My child is... My child is... Male Female

Child's City and State of Birth

Has the child been baptized? Has the child been baptized? Yes No

Please provide the name of the Church where he or she was baptized.

Please provide the address of the Church where he or she was baptized.

Mother's Name

Mother's Maiden Name

Mother's Phone Number

Mother's Email

Mother's Address

Mother's Religion Mother's ReligionRoman CatholicOther

If other, please list her religion here.

Father's Name

Father's Phone Number

Father's Email

Father's Address

Father's Religion Father's ReligionRoman CatholicOther

If other, please list his religion here.

Photography Waiver Photography Waiver I grant permission for my child to be photographed and for photos to be posted as described. I DO NOT grant permission for my child to be photographed.

E-signature: Please type your full legal name.

Today's Date [MM/DD/YYYY]