Contact Information and Religious History

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1. Please provide the following information:

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2. List below the name(s) of parent(s)/guardian(s) and present religious affiliation, if any:

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3. Best time to call via phone

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4. Child/Teen Lives With

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5. If child/teen lives with one parent/guardian, please indicate who has legal custody and/or if the child/teen also lives with a step-parent:

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6. If there is a joint custody arrangement, please provide alternate full address:

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7. What, if any, is your religious affiliation?

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8. Have your child/teen ever been baptized?

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9. If your child/teen received Baptism, include the name of the church, city and state and year received:

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10. In what denomination did your child/teen receive baptism?

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11. What was your child/teen's approximate age when baptized?

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12. What was your child/teen's baptismal name (if different from current name)?

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13. Place of Baptism

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14. If you were baptized as a Catholic, check those sacraments you have already received:

 
 20% of survey complete.

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