Church of Immaculate Heart of Mary

Scarsdale, NY

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Baptismal Certificate Request

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- Please provide the date (or approximate date) of the Baptism at IHM, the child's and parents' names, child's date of birth, and the address of where to mail the certificate. Also provide your telephone number and email address for any questions.
- Date of Baptism (approximate if necessary) REQUIRED Please fill out this field. Please enter a date.
- Child's Name REQUIRED Please fill out this field. Please enter valid data.
- Child's Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Father's Name REQUIRED Please fill out this field. Please enter valid data.
- Mother's Name (include Maiden Name) REQUIRED Please fill out this field. Please enter valid data.
- Address to Mail Certificate REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Telephone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Your Email Address REQUIRED Please fill out this field. Please enter an email address.
- Enter any Comments you may have (not required)
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