Parishioner Registration Form For new parishioners who wish to register. Step 1 of 5 20% Single/Head of HouseholdName(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Title First Middle/Maiden Last Nickname Birth Date(Required) Month Day Year Ethnic BackgroundWhiteHispanicAfrican AmericanAfricanAsianOtherGender Male Female Address(Required) Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email(Required) Home PhoneWork PhoneCell PhoneMarital Status Single Married Anniversary Date If you were not married in a Catholic Church, would you like one of our priests or deacons to contact you about having your marriage blessed by the Catholic Church? Yes No Occupation Employer Chuch Background(Required) Catholic Other Sacraments(Required) Baptized First Communion Confirmation I would like to get involved! Lector Eucharistic Minister Usher Choir member Prayer group Front Desk Volunteer Liturgy Committee Funeral Committee Food Pantry Help Other Please select an area of interest. Someone will contact you later, with more information. SpouseName Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Middle Last Nickname Birth Date Month Day Year Ethnic BackgroundWhiteHispanicAfrican AmericanAfricanAsianOtherGender Male Female Address Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email Home PhoneWork PhoneCell PhoneMarital Status Single Married Anniversary Date If you were not married in a Catholic Church, would you like one of our priests or deacons to contact you about having your marriage blessed by the Catholic Church? Yes No Occupation Employer Church Background Catholic Other Sacraments Baptized First Communion Confirmation ChildrenFirst ChildName First Middle Last Birth Date MM slash DD slash YYYY Grade Relationship Son Daughter Other Ethnic Background White Hispanic African American African Asian Other Church Background Catholic Other Sacraments Baptized First Communion Confirmation Second ChildName First Middle Last Birth Date Month Day Year Grade Relationship Son Daughter Other Ethnic BackgroundWhiteHispanicAfrican AmericanAfricanAsianOtherUntitled First Choice Second Choice Third Choice Church Background Catholic Other Sacraments Baptized First Communion Confirmation Additional Children? Yes No Additional ChildrenThird ChildName First Middle Last Birth Date Month Day Year Grade Relationship Son Daughter Other Ethnic BackgroundWhiteHispanicAfrican AmericanAfricanAsianOtherChurch Background Catholic Other Sacraments Baptized First Communion Confirmation Fourth ChildName First Middle Last Birth Date Month Day Year Grade Relationship Son Daughter Other Ethnic BackgroundWhiteHispanicAfrican AmericanAfricanAsianOtherChurch Background Catholic Other Sacraments Baptized First Communion Confirmation /StewardshipI Would you like to receive envelopes Yes No I would like to receive information on contributing through your checking account (electronic contributions) Yes No If you wish to contribute on a regular basis using a credit card, please click on the red "donate" button on the homepage of our website.CAPTCHA Δ
