Parish Registration Form

Parishioner Registration Form

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

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. Please enter valid data.

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

Family E-mail REQUIRED Please fill out this field. Please enter valid data.

Would you like to keep your contact information unlisted? Yes No

Head of Household (First Name) REQUIRED Please fill out this field. Please enter valid data.

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

Birth Date Please enter valid data.

Gender Male Female

Ethnicity Please enter valid data.

Sacraments Received Baptism First Reconciliation First Communion Confirmation Holy Matrimony

Marital Status Catholic Married Other Church Married (non-Catholic) Civil Union Single Divorced Separated Widowed

Do you want collection envelopes? (Select no if you'd prefer to give online) Yes No

Spouse Name (if married) Please enter valid data.

Phone Number Please enter a phone number.

Birth Date Please enter valid data.

Gender Male Female

Sacraments Received Baptism First Reconciliation First Communion Confirmation Holy Matrimony

Marriage Date/Church Please enter valid data.

Child's Name Please enter valid data.

Birth Date Please enter valid data.

Gender Male Female

Sacraments Received Baptism First Reconciliation First Communion Confirmation

Child's Name Please enter valid data.

Birth Date Please enter valid data.

Gender Male Female

Sacraments Received Baptism First Reconciliation First Communion Confirmation

Child's Name Please enter valid data.

Birth Date Please enter valid data.

Gender Male Female

Sacraments Received Baptism First Reconciliation First Communion Confirmation

Child's Name Please enter valid data.

Birth Date Please enter valid data.

Gender Male Female

Sacraments Received Baptism First Reconciliation First Communion Confirmation

Name of family member with Ministry wanting to become active in:

Please see Ministries.