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Registration Form

Please provide the following confidential information. If you would prefer a paper registration form, please contact the Parish Center to have a form mailed to you.

Tab through the form, when information is completed, press ENTER or click on the SUBMIT button.

Complete the information for all members of your household. Children 21 and over, and other adult residents must register separately.

Address of Household

Desired household mailing title (e.g. Mr. and Mrs. John Doe)
Address
Address Line 2
City
State
Zip Code
Phone Number	Check if unlisted

Family Member One

Last Name
First Name
Middle Initial
Gender
Date of Birth
Marital Status
Relationship (e.g. head of household, spouse, son, daughter, etc.)
Religion (if not Catholic)
Occupation
Employer/School
Education
Email Address

Marital Information, if applicable:

Date of Marriage
Place of Marriage (Church, City and State)
Check, if Catholic Marriage
Maiden Name, if applicable

Indicate Catholic sacraments received:

Baptism		If non-Catholic Baptism, please enter faith of Baptism
First Communion
Confirmation

Additional Comments

If no additional family members, please submit form. Otherwise enter information for additional family members below.

Family Member Two

Last Name
First Name
Middle Initial
Gender
Date of Birth
Marital Status
Relationship (e.g. head of household, spouse, son, daughter, etc.)
Religion (if not Catholic)
Occupation
Employer/School
Education
Email Address

Marital Information, if applicable:

Date of Marriage
Place of Marriage (Church, City and State)
Check, if Catholic Marriage
Maiden Name, if applicable

Indicate Catholic sacraments received:

Baptism		If non-Catholic Baptism, please enter faith of Baptism
First Communion
Confirmation

Additional Comments

If no additional family members, please submit form. Otherwise enter information for additional family members below.

Family Member Three

Last Name
First Name
Middle Initial
Gender
Date of Birth
Marital Status
Relationship (e.g. head of household, spouse, son, daughter, etc.)
Religion (if not Catholic)
Occupation
Employer/School
Education
Email Address

Marital Information, if applicable:

Date of Marriage
Place of Marriage (Church, City and State)
Check, if Catholic Marriage
Maiden Name, if applicable

Indicate Catholic sacraments received:

Baptism		If non-Catholic Baptism, please enter faith of Baptism
First Communion
Confirmation

Additional Comments

If no additional family members, please submit form. Otherwise enter information for additional family members below.

Family Member Four

Last Name
First Name
Middle Initial
Gender
Date of Birth
Marital Status
Relationship (e.g. head of household, spouse, son, daughter, etc.)
Religion (if not Catholic)
Occupation
Employer/School
Education
Email Address

Marital Information, if applicable:

Date of Marriage
Place of Marriage (Church, City and State)
Check, if Catholic Marriage
Maiden Name, if applicable

Indicate Catholic sacraments received:

Baptism		If non-Catholic Baptism, please enter faith of Baptism
First Communion
Confirmation

Additional Comments

If no additional family members, please submit form. Otherwise enter information for additional family members below.

Family Member Five

Last Name
First Name
Middle Initial
Gender
Date of Birth
Marital Status
Relationship (e.g. head of household, spouse, son, daughter, etc.)
Religion (if not Catholic)
Occupation
Employer/School
Education
Email Address

Marital Information, if applicable:

Date of Marriage
Place of Marriage (Church, City and State)
Check, if Catholic Marriage
Maiden Name, if applicable

Indicate Catholic sacraments received:

Baptism		If non-Catholic Baptism, please enter faith of Baptism
First Communion
Confirmation

Additional Comments

Please submit form. If more members in household, please submit a second form.