Register

What is the FAMILY NAME for this household?*

(ex - Smith Family)
Address*
Street Address City State ZIP Code
What is your family PHONE NUMBER?*
What is your PREFERRED email address?
Would you like to receive parish envelopes?*
- Yes
- No
Personal and Sacramental Information for HEAD of HOUSEHOLD
What are the First, Middle, Last (& Maiden if applicable) names of the Head of the Household?
First Middle Last Maiden
Date of Birth*
Place of Birth (City & State)
Occupation
Highest Grade Level of Education
Ethnicity
Contact Information
Work Phone Number Cell Phone Number Personal Email
Religion Head of Household
Other
Were you Baptized?*
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City and State where Church is located
Did you make First Holy Communion?*
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City and State where Church is located
Were you Confirmed?*
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City and State where Church is located
What is your marital status?*
- Single
- Married in the Catholic Church
- Married in a Civil Ceremony
- Divorced
- Widowed
Marriage Information
Date of Marriage Church of Marriage City and State where Church is located
Marriage Information
Date of Marriage Place of Marriage City and State

Personal and Sacramental Information for Spouse Information
What are the First, Middle, Last (and Maiden if applicable) names of your spouse?
First Middle Last Maiden
Date of Birth
Place of Birth
Occupation
Highest Grade Level of Education
Ethnicity
Contact Information
Work Phone Number Cell Phone Number Personal Email
Religion Spouse
Other
Were you Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City and State where Church is located
Did you make First Holy Communion?
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City and State where Church is located
Were you Confirmed?
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City and State where Church is located

Are there children under 25 in your household?
- Yes
- No
How many Children under 25

Personal and Sacramental Information for First Child
Name
First Middle Last
Sex
- Male
- Female
Date of Birth
Place of Birth (City and State)
Father's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Father's Name
First Middle Last
Mother's Name
- Listed as Head oh Household
- Listed as Spouse
- Other
Mother's Name
First Middle Last Maiden
Religion 1st Child
Other
Was the child Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City and State where Church is located
Has the child made First Holy Communion?
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City and State where Church is located
Was the child Confirmed?
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City and State where Church is located
School Information
School Name Grade Level
Attends Religious Education?
Ethnicity

Personal and Sacramental Information for Second Child
Name
First Middle Last
Sex
- Male
- Female
Date of Birth
Place of Birth (City and State)
Father's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Father's Name
First Middle Last
Mother's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Mother's Name
First Middle Last Maiden
Religion 2nd Child
Other
Was the Child Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City & State where Church is located
Has the child made First Holy Communion?
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City & State where Church is located
Was the child Confirmed?
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City & State where Church is located
School Information
School Name Grade Level
Attends Religious Education?
Ethnicity

Personal and Sacramental Information for Third Child
Name
First Middle Last
Sex
- Male
- Female
Date of Birth
Place of Birth (City & State)
Father's Name
- Listed as Head of the Houshold
- Listed as Spouse
- Other
Father's Name
First Middle Last
Mother's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Mother's Name
First Middle Last Maiden
Religion 3rd Child
Other
Was the Child Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of of Baptism City & State where Church is located
Has the Child Made First Holy Communion?
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City & State where Church is lcoated
Was the Child Confirmed?
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City & State where Church is located
School Information
School Name Grade Level
Attends Religious Education?
Ethnicity

Personal and Sacramental Information for Fourth Child
Name
First Middle Last
Sex
- Male
- Female
Date of Birth
Place of Birth (City & State)
Father's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Father's Name
First Middle Last
Mother's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Mother's Name
First Middle Last Maiden
Religion 4th Child
Other
Was the child Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City & State where Church is located
Has the child made First Holy Communion?
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City & State where Church is located
Was the child Confirmed?
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City & State where Church is located
School Information
School Name Grade Level
Attends Religious Education?
Ethnicity

Personal and Sacramental Information for Fifth Child
Name
First Middle Last
Sex
- Male
- Female
Date of Birth
Place of Birth (City & State)
Father's Name
- Listed as Head of the Houseold
- Listed as Spouse
- Other
Father's Name
First Middle Last
Mother's Name
- Listed as Head of Household
- Listed as Spouse
- Other
Mother's Name
First Middle Last Maiden
Religion 5th Child
Other
Was the Child Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City & State where Church is Located
Has the Child received First Holy Communion?
- Yes
- No
First Holy Communion Information
Date of First Holy Communion Church of First Holy Communion City & State where Church is Located
Was the Child Confirmed?
- Yes
- No
Confirmation Information
Date of Confirmation Church of Confirmation City & State where Church is Located
School Information
School Name Grade Level
Attends Religious Ed?
Ethnicity

Are there other members living in your household?
Are there other members living in your household?
- Yes
- No
How many other members are living in your household?

Personal and Sacramental Information for OTHER member of your household:
Name
First Middle Last
Sex
- Male
- Female
Relationship to Head of Household
Date of Birth
Place of Birth (City & State)
Religion Other
Other
Were they Baptized?
- Yes
- No
Baptism Information:
Date of Baptism Church of Baptism City & State where Church is located
Did they receive First Holy Communion?
- Yes
- No
First Holy Communion Information:
Date of First Holy Communion Church of First Holy Communion City & State where Church is located
Were they Confirmed?
- Yes
- No
Confirmation Information:
Date of Confirmation Church of Confirmation City & State where Church is located
Occupation
Highest Level of Education
Ethnicity

Personal and Sacramental Information for OTHER member of your household:
Name
First Middle Last
Sex
- Male
- Female
Relationship to Head of the Household
Date of Birth
Place of Birth (City & State)
Religion Other 2
Other
Were they Baptized?
- Yes
- No
Baptism Information
Date of Baptism Church of Baptism City & State where Church is located
Did they receive First Holy Communion?
- Yes
- No
First Holy Communion Information:
Date of First Holy Communion Church of First Holy Communion City & State where Church is Located
Were they Confirmed?
- Yes
- No
Confirmation information:
Date of Confirmation Church of Confirmation City & State where Church is Located
Occupation
Highest Level of Education
Ethnicity

Would you like to schedule an appointment to discuss something with a priest or have him visit your home?
- Yes
- No
Would you like to schedule an appointment to discuss something with a priest or have him visit your home?
- Yes
- No
Does anyone in your household need a sacramental visit due to illness or being homebound (please explain)?
If you are not married in the Church, would you like information on having your marriage blessed or on Church anullments?
Please list any talents that you or family members would like to share with the parish community.
Please list any parish ministries in which you would like to participate - a member of that ministry will be happy to contact you.
If you have any questions, comments, concerns or suggestions, please feel free to share them and we will be glad to follow up on them.
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Register

Parish Registration Form

Step 1 of 12

Personal and Sacramental Information for HEAD of HOUSEHOLD

Personal and Sacramental Information for Spouse Information

Personal and Sacramental Information for First Child

Personal and Sacramental Information for Second Child

Personal and Sacramental Information for Third Child

Personal and Sacramental Information for Fourth Child

Personal and Sacramental Information for Fifth Child

Are there other members living in your household?

Personal and Sacramental Information for OTHER member of your household:

Personal and Sacramental Information for OTHER member of your household:

Date of Baptism	Church of Baptism	City and State where Church is located

Date of First Holy Communion	Church of First Holy Communion	City and State where Church is located

Date of Confirmation	Church of Confirmation	City and State where Church is located

Date of Marriage	Church of Marriage	City and State where Church is located

Date of Baptism	Church of Baptism	City & State where Church is located

Date of Baptism	Church of of Baptism	City & State where Church is located

Date of First Holy Communion	Church of First Holy Communion	City & State where Church is lcoated

First	Middle	Last	Maiden

Work Phone Number	Cell Phone Number	Personal Email

First	Middle	Last	Maiden

Work Phone Number	Cell Phone Number	Personal Email