Parish Registration Form

Family Information

Mailing Name*

First Last

Head of Household or Family

Mailing Address*

Address Address Line 2 City State ZIP Code

Secondary Address

Street Address Address Line 2 City State ZIP Code

Primary Email*

Primary Phone*

Number of Dependents In Household*

Ok to print in Parish Publications*

Check means it is ok to print field in Parish Publications

Phone
Address
Email
None

Family Information

Head of Household Name*

First Middle Last Maiden (If Applicable)

Goes by Name (If Applicable)

Sex*

Male
Female

Email*

Phone*

Date of Birth*

Marital Status*

Single
Married
Divorced
Widowed

Married by Priest/Deacon*

Yes
No

Date of Wedding*

Place of Wedding*

Please include Church Name and City/State

Religious Affiliation*

Baptized*

Yes
No

Place of Baptism*

Please Include Name of Church and City/State

Sacraments/Activities Received*

Reconcilation
First Communion
Confirmation
RCIA
None

High School Attended*

College Attended

Occupation*

Place of Employment*

Any Special Concerns

(Physical or developmental needs; languages other than English spoken, etc.)

Spouse Information

Spouse Name*

First Middle Last Maiden (If Applicable)

Goes by Name (If Applicable)

Sex*

Male
Female

Email*

Phone*

Date of Birth*

Religious Affiliation*

Baptized*

Yes
No

Place of Baptism*

Please Include Name of Church and City/State

Sacraments/Activities Received*

Reconcilation
First Communion
Confirmation
RCIA
None

High School Attended*

College Attended

Occupation*

Place of Employment*

Any Special Concerns

(Physical or developmental needs; languages other than English spoken, etc.)

Step 1 of 3

Family Information

Family Information

Spouse Information

Dependent #1 Information

Dependent #2 Information

Dependent #3 Information

Additional Dependents

Additional Information