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Child’s Surname *

Child’s Date of Birth

Child’s Address *

Address Line 2

County / Postcode *

Eircode

Is this child Baptised?

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Church of Baptism

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Date of Baptism

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Mother’s / Guardian’s Firstname *

Mother’s / Guardian’s Surname *

Father’s / Guardian’s Firstname

Father’s / Guardian’s Surname

Primary Contact Mobile Phone Number *

Primary Contact Email *

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