Catholic Diocese of Dallas

Emergency Baptism Form

Hospital Name*
Date of Baptism*
Name of Baptized Child*
Mothers Maiden Name*
Fathers Name*
Born in City State*
Birth Day, Month, Year*
According to the Rite of the Roman Catholic Church
Baptized By*
Parents Permanent Address*
Parent Phone No.
Name of Catholic Witnesses
Parents Email Address
As Recorded in the Sick Call Register of this Medical Center