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Parishioner Registration Form

To register as a parishioner, please fill out the form below and submit.

* Items are required

Family Information
* Household Last Name
* Zip
* Address
* City
* State

* Contact Email Address
*Telephone
Where is your home located?
(Country Club/Cross Streets/Development/Etc)

Send Church Envelopes

Married by a Priest?

Children

Husband
First Name
Email Address
Birth Date
Religious Affiliation

Marital Status	Baptized
First Communion	Confirmation

Wife
First Name
Last Name - If different from household last name
Email Address
Birth Date
Religious Affiliation

Marital Status	Baptized
First Communion	Confirmation

Children / Other Family Members

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?

Name	Last name if different	Birthdate	Family Member	Baptized	1st Communion	Confirmation
If family member is a school age child, what school?