White Robed Monks of St. Benedict

Baptism Petition Form

Peace be with you.

Baptism Date (MM/DD/YY): 
Baptizee's Last Name:  

Please enter today's date: 

• We have read and understand the Frequently Asked Questions regarding Baptism and agree to work with the White Robed Monks of St. Benedict given the information contained therein. YES. NO. (Please note: A NO response may place this petition into a Deferred Status until a couple's as yet unanswered questions may be answered and the couple may freely check YES. Please refer inquiries to: Father Abbot. If you have read the FAQ's and have no further question at this time, please check YES.)
  

YES, this is a NEW Baptism Petition we are about to submit.
YES, this is an UPDATED Baptism Petition we are now about to submit.

We found this site by: (Please click arrow at right) Own Referral WEB Surf Vendor Referral *Friend Referral *Other

If *"Friend" or "Other", please type in name or source of contact:

Officiant

If you have already spoken with a priest/deacon and s/he has agreed to officiate at your ceremony, please note the officiant's name here:

Please enter Baptizee's (Adult or Child) information (as will appear in official record and on baptismal certificate):

• First Name:     
• Middle Name: 
• Middle Initial:  
• Surname:         (Please be sure to note without comma if "Jr." or "II" etc.)
• Birth Date (MM/DD/YY): 
• City of Birth:   
• State of Birth (USA) of Birth:    Please select-USA AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
• Country of Birth:    United States Afghanistan Albania Algeria Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Myanmar Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Democratic Republic of the Congo Republic of the Costa Rica Cote dIvoire Ivory Coast Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Republic of Germany Ghana Gibraltar Great Britain & Northern Ireland Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Eire Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Republic of South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Moldova Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Lucia Saint Pierre & Miquelon Saint Vincent & Grenadines San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Montenegro Yugoslavia Seychelles Sierra Leone Singapore Slovak Republic Slovakia Slovenia Solomon Islands South Africa Spain Sri Lanka St. Christopher St. Kitts & Nevis Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Islands Western Samoa Yemen Zambia Zimbabwe

Please enter Parental information (If petitioning for Adult Baptism, complete as Mother if Female; Father if Male (as will appear on official record):

• Mother's First Name:     
• Mother's Middle Name: 
• Mother's Surname:         
• Religious Affiliation (If none, please enter OPEN or NONE):
  • Mother's Religion of Origin: 
  • Has Mother been baptized:   YES NO
  • Has Mother been confirmed: YES NO
• Mother's e-mail address: 
• Mother's work phone number with Area Code: 
• Mother's home phone number with Area Code: 
• Mother's cell hone number with Area Code:      

• Father's First Name:     
• Father's Middle Name: 
• Father's Middle Initial:  
• Father's Surname:         (Please be sure to note without comma if "Jr." or "II" etc.)
• Religious Affiliation (If none, please enter OPEN or NONE):
  • Father's Religion of Origin: 
  • Has Father been baptized:   YES NO
  • Has Father been confirmed: YES NO
• Father's e-mail address: 
• Father's work phone number with Area Code: 
• Father's cell phone number with Area Code:    
• If different than mother's, Father's home phone number with Area Code: 

• Address: 
• City:       
• USA only, State-Abreviation:  Not Applicable AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NB NC NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
• USA only, State full name:      Select One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
• USA ONLY just 5 digit ZIP Code: 
  • If in USA, to insure prompt processing of this form, PLEASE obtain and fill-in below your ZIP+4.
    To obtain your ZIP+4 please click: USPS Zip Code Retrieval Unit. Your information (usually) will be saved. When +4 is obtained, just click browser's tool bar BACK button at top of USPS page to return to this form.
    
    • Zip+4 currently in USPS data base. YES  NO   If NO, then insert OOOO in next field.Thank you.)
    • Please enter ONLY +4 here: 
• Outside USA, Province: 
• Outside USA Postal Code: 
• Country:  United States Afghanistan Albania Algeria Andorra Angola Anguilla Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burma Myanmar Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Colombia Comoros Congo Democratic Republic of the Congo Republic of the Costa Rica Cote dIvoire Ivory Coast Croatia Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Faroe Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Republic of Germany Ghana Gibraltar Great Britain & Northern Ireland Greece Greenland Grenada Guadeloupe Guatemala Guinea Guinea Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Ireland Eire Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea Republic of South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Republic of Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mexico Moldova Mongolia Montserrat Morocco Mozambique Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Island Poland Portugal Qatar Reunion Romania Russia Rwanda Saint Helena Saint Lucia Saint Pierre & Miquelon Saint Vincent & Grenadines San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Montenegro Yugoslavia Seychelles Sierra Leone Singapore Slovak Republic Slovakia Slovenia Solomon Islands South Africa Spain Sri Lanka St. Christopher St. Kitts & Nevis Sudan Suriname Swaziland Sweden Switzerland Syrian Arab Republic Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad & Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Wallis & Futuna Islands Western Samoa Yemen Zambia Zimbabwe
  (If another address is to be the permanent address, please write-in that address below in Special Instructions.)

• Godmother's First Name:     
• Godmother's Middle Name: 
• Godmother's Surname:         
• Godmother's Religious Affiliation (If none, please enter OPEN or NONE):
• Godmother's Religion of Origin: 
  • Has Godmother been baptized:   YES NO
  • Has Godmother been confirmed: YES NO

• Godfather's First Name:     
• Godfather's Middle Name: 
• Godfather's Surname:          (Please be sure to note without comma if "Jr." or "II" etc.)
• Godfather's Religious Affiliation (If none, please enter OPEN or NONE):
• Godfather's Religion of Origin: 
  • Has Godfather been baptized:   YES NO
  • Has Godfather been confirmed: YES NO

• Baptismal Date:  Pls Select Month January February March April May June July August September October November December    Pls Select Date 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th 21st 22nd 23rd 24th 25th 26th 27th 28th 29th 30th 31st    Pls Select Year 2008 2009 2010
• Baptism Time:  <Please enter WITHOUT COLON (:)>   AM  PM
• Baptism Location: 
  • Address: 
  • City: 
  • State: Pls Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming Province:   
  • ZIP/Postal Code: 
  • Country (if not USA, click "Outside"):  United States Outside United States
  • Country (if not USA, please type-in Country): 
  • Site Coordinator:
  • Phone number with Area Code: 
  • FAX number with Area Code:   
  • E-mail address: 
• Approximate Number of Guests (maximum):
• Additional Comments: (Please do NOT hit ENTER when entering information.)
  

Congratulations and Thank you.

Peace and Joy to you and yours.

The White Robed Monks of St. Benedict

Note: If you DO NOT receive a Thank You Notice upon submission, the CPU from which you are about to transmit this form may have a firewall that does not allow a cgi script to send a Thank You Notice-Your data has transmitted message. This is especially so if you receive a 404 error notice saying "File cannot be found." All is well. Your information has probably transmitted. If you receive "File cannot be found.," please hit REFRESH and the Thank You Notice should appear.

In any case, as added insurance, we strongly recommend that you send a separate e-mail to Web Master with Subject being Baptism Petition and in message area: your contact e-mail, Last Name , Date of Baptism (mm-dd-yy) and phone number. We will confirm within 24 hours whether or not we received your petition. Thank you.