Emergency Baptism Form

Also See:

Summary Regarding Emergency Baptism and Confirmation of Infants and Adults
Emergency Confirmation Memo
Handbook of Sacramental Records [see "Baptismal Records"]

Hospital or Institution Name

Date of Baptism

Name of Baptized Child

Mother's Full Maiden Name

Father's Name

Born in City State

Birthday (Month, Day, Year)

PLEASE NOTE

In the case of emergency sacraments performed when in danger of death, the Sacrament of Confirmation can only be supplied by a Catholic Priest/Bishop. Please see Emergency Baptism/ Confirmation Memo for more information.

Was the baptism performed according to the Rite of the Roman Catholic Church?

Yes

Was an Emergency Confirmation performed by a Catholic Priest?

Yes

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

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