St. Mary's Catholic Church

89 ST. MARY’S PLACE

PO BOX 1537

BUNNELL, FL 32110

PHONE: (386) 437-5098 FAX: (386) 437-5091

Rev. Fr. Slawomir Podsiedlik

BAPTISM CHECKLIST

Date/Time of Baptism: ______________________________________________________________

Name of Child: ______________________________________________________________

Address/Phone#: ______________________________________________________________

Date of Birth: ______________________________________________________________

Place of Birth: ______________________________________________________________

Father’s Name: ______________________________________________________________

Religion of Father: ______________________________________________________________

Mother’s Maiden Name: ______________________________________________________________

Religion of Mother: ______________________________________________________________

Parents Married by Catholic Priest: Yes No

Registered at St. Mary’s? ______________________________________________________________

Godfather’s Name: ______________________________________________________________

Sponsor Certificate: ______________________________________________________________

Is Godfather a Catholic? Yes No

Godmother’s Name: ______________________________________________________________

Sponsor Certificate: ______________________________________________________________

Is Godmother a Catholic? Yes No

Is either Godparent represented by Proxy? Yes No

Name of Proxy: ______________________________________________________________

Was the child privately baptized? ______________________________________________________________

Was the child adopted? ______________________________________________________________

Name of Priest: _Fr. Slawomir Podsiedlik _____________________________