General Information

* Registration Date

/ /

* Family Name

* Address

* City

* State

* Zip

Phone

( ) - ext

Email Address

Add to Email List?

Yes
No

Permission to publish telephone, address and e-mail in Parish Directory:

Phone

Yes
No

Address

Yes
No

Email

Yes
No

Head of Household Information

* Salutation

* FIrst Name

Middle Name

Last Name (if different)

* Date of Birth

/ /

Occupation

* Catholic?

Yes
No

If no, what Religion?

* Baptized?

Yes
No

* First Communion?

Yes
No

* Confirmed?

Yes
No

RCIA?

Yes
No

If yes, what church?

Marital Status

Single
Married

Marriage Date

/ /

Priest or Deacon Name

Church

City

State

Spouse Information

Salutation

First Name

Middle Name

Last Name (if different)

Maiden Name

Date of Birth

/ /

Occupation

Catholic?

Yes
No

If no, what religion?

Baptized?

Yes
No

First Communion?

Yes
No

Confirmed?

Yes
No

RCIA?

Yes
No

If yes, what church?

Dependent Children

Child 1

First Name

Middle Name

Last Name

Gender

Male
Female

Date of Birth

/ /

Baptized?

Yes
No

Church

City, State

Date (if known)

First Communion?

Yes
No

Church

City, State

Date (if known)

Confirmation

Yes
No

Church

City, State

Date (if known)

Child 2

First Name

Middle Name

Last Name

Gender

Male
Female

Date of Birth

/ /

Baptized?

Yes
No

Church

City, State

Date (if known)

First Communion?

Yes
No

Church

City, State

Date (if known)

Confirmation

Yes
No

Church

City, State

Date (if known)

Child 3

First Name

Middle Name

Last Name

Gender

Male
Female

Date of Birth

/ /

Baptized?

Yes
No

Church

City, State

Date (if known)

First Communion?

Yes
No

Church

City, State

Date (if known)

Confirmation

Yes
No

Church

City, State

Date (if known)

Child 4

First Name

Middle Name

Last Name

Gender

Male
Female

Date of Birth

/ /

Baptized?

Yes
No

Church

City, State

Date (if known)

First Communion?

Yes
No

Church

City, State

Date (if known)

Confirmation

Yes
No

Church

City, State

Date (if known)

Children's Ministry K-8

Becoming Catholic (RCIA)

Registration

General Information

Head of Household Information

Spouse Information

Dependent Children

Child 1

Child 2

Child 3

Child 4