Baptism Request Form

This form can be submitted online to the Parish Office. For any questions please contact Joanna Rogers at (608) 837-7381 or [email protected] .

Child's Name: (Legal first, middle, and last) REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Place of child's birth (City & State) REQUIRED Please fill out this field. Please enter valid data.

Please provide correct pronunciation of name: Please enter valid data.

Gender REQUIRED Please fill out this field.

Father's Information

Father's Name: (Legal first, middle, and last) REQUIRED Please fill out this field. Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.
Mother's Name: (Legal first, middle, MAIDEN, and last) REQUIRED Please fill out this field. Please enter valid data.

Mother's Information

Religion REQUIRED Please fill out this field. Please enter valid data.

Contact Information

Home Address REQUIRED Please fill out this field. Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.
Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.

Are you a registered member of Epiphany of the Lord Parish? REQUIRED Yes No Please fill out this field.

Is this your first child being baptized? REQUIRED Yes No Please fill out this field.

If no, how long has it been since your last child was baptized? Please enter valid data.

Are the parents married? REQUIRED Yes No Please fill out this field.

Location of Marriage (Place, City & State) REQUIRED Please fill out this field.

Today's Date REQUIRED Please fill out this field. Please enter a date.

Comments or Questions

Requested Church for Baptism REQUIRED Sacred Hearts of Jesus and Mary, Sun Prairie St. Albert the Great, Sun Prairie St. Mary of the Nativity, Marshall St. Joseph, Waterloo Please fill out this field.