Erie Tri-County Catholic
Family of Parishes

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Baptismal Registration Form For Infants (age of 7 and under)

- Sacraments

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- Parish Information
- What Parish are you registered with and will you celebrate your sacraments in? REQUIRED St.Mary's (Tillsonburg) Sacred Heart (Langton) St. Michael's (Walsh) Please fill out this field.
- SECTION ONE
  Information about the Child
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last Name REQUIRED Please fill out this field. Please enter valid data.
- Sex: REQUIRED Please fill out this field.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Place of Birth REQUIRED Please fill out this field. Please enter valid data.
- SECTION TWO
  Information about the Parents
- Mother - Last Name/ First Name/Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Religion of Mother REQUIRED Please fill out this field. Please enter valid data.
- Mother's Address (full address - include 911# and postal code) REQUIRED Please fill out this field. Please enter valid data.
- Mother's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Mother's Email Address REQUIRED Please fill out this field. Please enter an email address.
- Father - Last Name/ First Name/Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Religion of Father REQUIRED Please fill out this field. Please enter valid data.
- Father's Address (full address - include 911# and postal code) REQUIRED Please fill out this field. Please enter valid data.
- Father's Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Father's Email Address REQUIRED Please fill out this field. Please enter an email address.
- SECTION THREE
  Information Regarding Marriage and Family
- Are you Married REQUIRED Yes No Divorced Separated (not living in the same household) Please fill out this field.
- Date of Marriage Please enter a date.
- At what place (church, event space, etc.) where you married? Please enter valid data.
- What city or town did your marriage take place in? Please enter valid data.
- Number of Children Please enter valid data.
- Ages of Other Children Please enter valid data.
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