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Parish Registration Form
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Membership Information
In this section we collect information about Parish membership and envelopes
Are you a new parishioner?
(Required)
Yes
No
Are you updating information?
(Required)
Yes
No
Do you want to receive envelopes from our church?
(Required)
Yes
No
Do you currently receive envelopes from our church?
(Required)
Yes
No
Contact Information
In this section we collect information on how to contact you
Name
(Required)
First
Last
Address
(Required)
Street Address
Address Line 2
City
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
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
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Date of Birth
(Required)
Month
Day
Year
Marital Status
(Required)
Choose One
Single
Engaged
Married Civilly
Married in Catholic Church
Divorced
Widowed
Email
(Required)
Phone
(Required)
Preferred Language
Religion
Spouse Name
(Required)
First
Last
Spouse Date of Birth
(Required)
Month
Day
Year
Are you interested in volunteering in a Parish Ministry?
(Required)
Yes
No
Maybe
Do you have children and/or other adults living at home with you
(Required)
Children would be classified as those 18 years old or younger
Yes, Children
Yes, Other Adults
Yes, Both
No, Neither
Number of Children Living at Home
(Required)
Child #1 Information
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
This child has received the following Sacraments
Baptism
First Holy Communion
Confirmation
Child #2 Information
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
This child has received the following Sacraments
Baptism
First Holy Communion
Confirmation
Child #3 Information
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
This child has received the following Sacraments
Baptism
First Holy Communion
Confirmation
Child #4 Information
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
This child has received the following Sacraments
Baptism
First Holy Communion
Confirmation
Child #5 Information
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
This child has received the following Sacraments
Baptism
First Holy Communion
Confirmation
Child #6 Information
Name
(Required)
First
Last
Date of Birth
(Required)
Month
Day
Year
Gender
(Required)
Male
Female
This child has received the following Sacraments
Baptism
First Holy Communion
Confirmation
Other Adults Living in The Home
In this section we collect information about other adults who live in your home
Other Adults Living In Home Information
(Required)
Name
Relationship
Date of Birth (mm/dd/yyyy)
Add
Remove
Click the plus button on the right side to add another row to input information for additional entries
Sacraments
In this section, let us know if anyone in your home needs to receive any Sacraments, including Marriage, Convalidation, RCIA, Baptism, First Holy Communion and Confirmation.
Does anyone in your household need to receive a Sacrament?
Yes
No
Not Sure
If "not sure", please explain. If "yes" let us know which Sacrament(s).
Additional Information
Additional Information or Comments
Phone
This field is for validation purposes and should be left unchanged.
