Form

Last Name (of child to be baptized):*

First & Middle Names (of child to be baptized)*

Date of Birth (MM/DD/YYYY)*

City and State where child was born*

Anticipated Date & Time of Baptism (read item 5 of policy brochure before completing)*

Father's Name (first, middle, last)*

Father's Religion*

Mother's Name (first, middle & maiden)*

Mother's Religion*

Godfather's Name (first, middle, last) Read carefully item 3 of policy brochure before completing*

Godfather's Religion*

Godmother's Name (first, middle, maiden)*

Godmother's Religion*

Since St. Albert Chapel & Student Center is not a geographical Church parish, one of the following circumstances must apply in order for a baptism to take place at St. Albert.

Choose the circumstance that applies to your request.*

At least one parent resides on the Southeastern Louisiana University Campus At least one parent is enrolled at least part-time at Southeastern Louisiana University At least one parent is employed at least part-time by Southeastern Louisiana University Parents are active identifiable members of the St. Albert Support Community and are regularly practicing their Catholic faith at St. Albert Catholic Chapel & Student Center Parents are NOT registered, active, or otherwise identifiable members of another geographical Catholic Church Parish

If selected godparents are not active members of St. Albert Chapel & Student Center support community, a letter from their respective pastor is necessary, testifying that they are church-going, practicing membert of their Church parish, and meet the other qualifications established by the Catholic Church to serve in this role.

Has another priest or Catholic Church parish refused a request to baptize your child?*

If yes, which priest or Catholic Church parish?

PLEASE NOTE: Under normal circumstances, by policy of the Diocese of Baton Rouge, parents requesting baptism of a child must be identifiable active members of a Catholic worship community, have attended a pre-baptism instruction session, be actively participating at Sundy and Holy Day Masses, and be regularly contributing to the support of their church. If your circumstances are not normal in any of these ways or other ways, please spead with the St. Albert Chaplain personally.

If parents of a child to be baptized were married by a Catholic priest or deacon, in which Church did the marriage take place?

Diocese (Baton Rouge, New Orleans, etc.)

Under normal circumstances, parents should be married in the Catholic Church. If parents are not married, or their marriage is not "blessed" in the Catholic Church, please speak with the St. Albert Chaplain.

If parents requesting baptism of a child are NOT married, either a state-issued "Certificate of Live Birth" or a "Declaration of Paternity" signed by the father of the child, sill be necessary before the father's name can be recorded in the Baptism record or appear on a Certificate of Baptism issued by St. Albert Chapel

Mailing Address of Child's Parent(s):*

City:*

State:*

Zip code:*

Mother's e-mail:*

Father's e-mail:

Phone:*

Alternate Phone Number:

PARENTAL DECLARATION:*

I have fully read and understand the \"Policy regarding the Sacrament of Baptism of Infants.

Parent's "signature"*

Today's date*

St. Albert Pre-Baptismal Information Form