Parish Registration

Household Name REQUIRED Please fill out this field. Please enter valid data.

Street Address 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Date REQUIRED Please fill out this field. Please enter a date.

Reason for joining the parish REQUIRED Please fill out this field.

Would you like to receive physical envelopes? REQUIRED No, I'd prefer to give online. Yes, I'd like envelopes. Please fill out this field.

Head of and/or Main Contact of Household

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Nick Name Please enter valid data.

Date of birth (Month, day, Year) REQUIRED Please fill out this field. Please enter valid data.

Sex REQUIRED Please fill out this field.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Religion REQUIRED Please fill out this field. Please enter valid data.

Marital Status REQUIRED Please fill out this field.

Is your marriage recognized by the Catholic Church? REQUIRED Yes No N/A Please fill out this field.

Sacraments Received: Check all that apply REQUIRED None Baptized First Holy Communion Confirmation Please fill out this field.

Ethnicity REQUIRED Please fill out this field.

Would you like to be contacted by the Pastor in reference to Marriage or Marriage Con-validation? Y/N

Would you (or a member of your household) like to be learn more about any of these ministries? Altar Server Bringing Eucharist to the Home Bound Lector (reading at Mass) Music/Choir Religious Education Usher Youth Group None of the above

Occupation Please enter valid data.

Spouse and/or Secondary Contact of Houehold

None

First Name Please enter valid data.

Last Name Please enter valid data.

Nick Name Please enter valid data.

Date of birth (Month, day, Year) Please enter valid data.

Sex

Email Please enter an email address.

Phone Number Please enter a phone number.

Religion Please enter valid data.

Sacraments Received: Check all that apply None Baptized First Holy Communion Confirmation

Ethnicity

Occupation Please enter valid data.

Parish Registration

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Head of and/or Main Contact of Household

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