St.

Joseph the Worker Church

10816 Mountain View Ave., Loma Linda, CA 92354
(909)796-4308
(PLEASE PRINT CLEARLY)
GODPARENT FORM FOR INFANT BAPTISM
Child’s Name:
_____________________________________________________________________________________________________________
_________________________
First Last MI

PLEASE HAVE EACH GODPARENT FILL OUT THIS FORM COMPLETELY, TAKE IT TO
THEIR PARISH OFFICE AND HAVE THEIR PARISH’S SEAL IMPRINTED ON THIS
FORM.
Godparent,
Before signing this please read the following church requirement for godparents. In accordance with the
laws of the Roman Catholic Church, Canon Law 872-874, Chap. IV, pgs. 1060-1062, & Canon Law 892-893,
Chap. IV, pgs. 1089-1090:

Be a person suitable for this role, selected by the candidate’s family, and having the
intention of
fulfilling this role, and a practicing Catholic who is registered at a parish.
Be at least 16 years of age; 18 years in our Diocese of San Bernardino requested by
Bishop Gerald R. Barnes
Have received the sacraments of Initiation: Baptism, Holy Eucharist, and
Confirmation, and one
who leads a life of faith in keeping with the function to be taken on
Be neither the mother nor the father of the person to be baptized

If married to each other, must be in a Sacramental Marriage. The Godparent’s role is, together with
the parents, to present the child for Baptism and to help him/her to live a Christian life within the Catholic
Church, fulfilling the duties inherent in Baptism.

PROSPECTIVE GODPARENT, PLEASE PRINT

Name: _____________________________________________________________________________/ Single: Yes / No:

Married: Yes/No: In the Roman Catholic Church? Yes / No

Address: __________________________________________________________________________ / If other:

_________________________________________________________

City/State/ Zip:
________________________________________________________________________________________________

Telephone: _________________________________________ Cell phone: _______________________________* We must

have a home Telephone number to contact you!
Your Baptism date and location (parish, city, and state):
_______________________________________________________________________________________________
Your First Communion and Confirmation date and location (parish, city, and state):
___________________________________________________________________

I DECLARE THAT I AM A REGISTERED MEMBER OF THE PARISH STATED BELOW AND I FULFILL THE
REQUIREMENTS OF CANON LAW TO BE A GODPARENT.

___________________________________________________ ______ Date:

_________/________/__________
Prospective Godparent’s Signature

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I certify that _______________________________________________ is a registered member of this parish, is a
practicing Catholic and is eligible to act as a Godparent for the Sacrament of Baptism.

_________________________________________________________ Date: ________/__________/___________

Signed (Pastor of prospective Godparent’s parish)

Parish: __________________________________________________

City/ State: _____________________________________________

Church Seal