Registration Form If you have not registered with our Parish, please do so now. Title* Mr. Mrs. Ms. Dr. First Name* Last Name* Middle Initial* Nickname E-Mail Address Home Address (Street)* City* Zip Code* Cell Phone Number Land Line Number Head of Household InformationName* First Last Date of Birth:* MM slash DD slash YYYY Gender:* Female Male Religion:* Languages SpokenFirst Language:* Second Language: Special Needs (describe): Occupation:* Baptism Date: MM slash DD slash YYYY Confirmation Date: MM slash DD slash YYYY First Communion Date: MM slash DD slash YYYY Date of Marriage: MM slash DD slash YYYY Marital Status:* Single Married Divorced Widowed Add spouse's information: Add spouse’s information SpouseName* First Last Date of Birth:* MM slash DD slash YYYY Gender:* Female Male Religion:* E-Mail Address Languages Spoken:First Language:* Second Language: Special Needs (describe): Occupation:* Baptism Date: MM slash DD slash YYYY Confirmation Date: MM slash DD slash YYYY First Communion Date: MM slash DD slash YYYY Was your current marriage celebrated in the Catholic church?* Yes No n/a Date of Marriage: MM slash DD slash YYYY Maiden Name: ChildrenAdd child's information: 1 Add child’s information Child 1:Name First Last Date of Birth: MM slash DD slash YYYY Gender: Female Male Languages Spoken:First Language: Second Language: School Attending: Special Needs (describe): Baptism Date: MM slash DD slash YYYY Confirmation Date: MM slash DD slash YYYY First Communion Date: MM slash DD slash YYYY Add child's information: 2 Add child’s information Child 2:Name First Last Date of Birth: MM slash DD slash YYYY Gender: Female Male Languages Spoken:First Language: Second Language: School Attending: Special Needs (describe): Baptism Date: MM slash DD slash YYYY Confirmation Date: MM slash DD slash YYYY First Communion Date: MM slash DD slash YYYY Add child's information: 3 Add child’s information Child 3:Name First Last Date of Birth: MM slash DD slash YYYY Gender: Female Male Languages Spoken:First Language: Second Language: School Attending: Special Needs (describe): Baptism Date: MM slash DD slash YYYY Confirmation Date: MM slash DD slash YYYY First Communion Date: MM slash DD slash YYYY Add child's information: 4 Add child’s information Child 4:Name First Last Date of Birth: MM slash DD slash YYYY Gender: Female Male Languages Spoken:First Language: Second Language: School Attending: Special Needs (describe): Baptism Date: MM slash DD slash YYYY Confirmation Date: MM slash DD slash YYYY First Communion Date: MM slash DD slash YYYY ReleaseRelease* Registration includes permission to use your family photos in parish publications.
