Registration for the Sacrament of Baptism

Complete the form below.
Questions before registering?
LuCinda Buckner
Office Manager
(816) 453-2089 ext 5.
Thank you and God Bless!

Carefully enter all required information.
Do not use ALL CAPS and double check spelling.
Certificate will be created from this form.

CHILD TO BE BAPTIZED:

FIRST NAME Please enter valid data.
MIDDLE NAME Please enter valid data.
LAST NAME Please enter valid data.
GENDER REQUIRED Male Female N/A Registering before child is born Please fill out this field.
DATE OF BIRTH Please enter valid data.
CITY AND STATE OF BIRTH Please enter valid data.

FATHER'S INFORMATION

FIRST MIDDLE AND LAST NAME REQUIRED Please fill out this field. Please enter valid data.
Dad's Email REQUIRED Please fill out this field. Please enter an email address.
PHONE REQUIRED Please fill out this field. Please enter valid data.
RELIGION REQUIRED ROMAN CATHOLIC PROTESTANT OTHER Please fill out this field.

MOTHER'S INFORMATION

FIRST MIDDLE AND LAST NAME REQUIRED Please fill out this field. Please enter valid data.
MAIDEN NAME REQUIRED Please fill out this field. Please enter valid data.
Mom's Email REQUIRED Please fill out this field. Please enter an email address.
Phone REQUIRED Please fill out this field. Please enter valid data.
RELIGION REQUIRED ROMAN CATHOLIC PROTESTANT OTHER Please fill out this field.

ADDITIONAL INFORMATION

St. Andrew the Apostle