Today's Date: ______________________
SACRAMENT REQUESTED
Confirmation
Rite of Christian Initiation of Adults (RCIA)
Profession of Faith
Children's Catechumenate
CANDIDATE INFORMATION (as it appears on child's birth certificate)
Candidate's Legal Name: ______________________________ ______________________________ ______________________________
(First) (Last)
Date of Birth: ____________________ Place of Birth: __________________________________________
(City and State)
CONTACT INFORMATION (information regarding child's sacrament will be sent to information below)
Preferred Phone #: _______________________________ Preferred Email: _____________________________________________
Mailing Address: ________________________________________ _________ ____________________ ___________ ______________
(City) (State) (Zip Code)
PARENT INFORMATION
Father's Legal Name: _______________________ _______________________ ________________________
Religion: _________________
(First) (Last)
Mother's Legal Name: _______________________ _______________________ ________________________
Religion: _________________
Mother's Maiden Name: _________________________________
Marital Status:
Married Single Divorced Separated Other: __________________________________________________
Is your family registered at St. Theresa? Y N If no, where? ________________________________________________________________________
Would you like to be registered as active parishoners and receive notifications regarding our church? Y N
GODPARENT INFORMATION: NONE FOR FIRST COMMUNION (at least one sponsor must be fully initiated Catholic)
Name: __________________________ __________________________ ____________________________ Religion: _________________
(First) (Last)
Name: __________________________ __________________________ ____________________________ Religion: _________________
(First) (Last)
FOR OFFICE USE ONLY
Sacrament Date: _____________________
Mass Time: ________ Date Attended Prep Class: _____________________
Celebrant: ____________________________________________ Confirmation Name: __________________________________
NOTES:
Record Date: ________________________
_____ _____ _____
(Vol) (Page) (No.)
ParishSoft Date: _____________________
Certificate Mailed Date: _______________________
SACRAMENT REQUEST FORM
(PLEASE USE ONE FORM PER CANDIDATE)
A baptized non-Catholic is NOT eligible to serve as a godparent. However, he or she may serve as a Christian witness.
Only one godparent is required. If a godparent is not able to be present, he or she may request a proxy to stand in his/her place.
Record Information:
(Middle)
(Address)
(Middle)
(Middle)
(Middle)
(Apt)
PM
Female
Baptism (Will need to submit copy of birth certificate)
First Communion
(No sponsor needed)
(MM/DD/YYYY)
(First) (Last)
(Middle)
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