Parish Registration

Thanks for taking a moment to register your household's information with our parish's office. Please fill out the form as completely as possible and then click submit. This information allows us to know more about you and enables us to be a greater service to you.

REGISTRATION

Is this information:
Required*

	New Registration
	An Update to a Current Registration

FAMILY HOME ADDRESS

Home Address

Street 1*

Street 2

City*

State*

Zip*

PRIMARY REGISTRANT

First Name*

Middle Name

Last Name*

Primary Phone

Required* --

Secondary Phone

-- ext

Email Address

Gender

	Male
	Female

Birthdate

Required* //

Ethnicity

	Asian
	African
	Hispanic
	Native American

	Pacific Islander
	Southeast Asia
	White, European-American
	Other

Sacraments received

(check all that apply)

	Baptism
	First Communion

	Confirmation
	Married in Catholic Church

Marital Status

	Single
	Married
	Separated

	Divorced
	Widowed
	Engaged

SPOUSE/SECOND REGISTRANT

First Name

Middle Name

Last Name

Primary Phone

Secondary Phone

-- ext

E-mail Address

Gender

	Male
	Female

Birthdate

Ethnicity

	Asian
	African
	Hispanic
	Native American

	Pacific Islander
	Southeast Asia
	White, European-American
	Other

Sacraments Received

(check all that apply)

	Baptism
	First Communion

	Confirmation
	Married in Catholic Church

CHILDREN

CHILD 1

First Name

Middle Name

Last Name

Gender

	Male
	Female

Birthdate

Ethnicity

(check all that apply)

	Asian
	African
	Hispanic
	Native American

	Pacific Islander
	Southeast Asia
	White, European-American
	Other

Sacraments received

	Baptism
	First Communion
	Confirmation

CHILD 2

First Name

Last Name

Gender

	Male
	Female

Birthdate

Ethnicity

	Asian
	African
	Hispanic
	Native American

	Pacific Islander
	Southeast Asia
	White, European-American
	Other

Sacraments received

	Baptism
	First Communion
	Confirmation

CHILD 3

First Name

Last Name

Gender

	Male
	Female

Birthdate

Ethnicity

	Asian
	African
	Hispanic
	Native American

	Pacific Islander
	Southeast Asia
	White, European-American
	Other

Sacraments received

	Baptism
	First Communion
	Confirmation

CHILD 4

First Name

Last Name

Gender

	Male
	Female

Birthdate

Ethnicity

	Asian
	African
	Hispanic
	Native American

	Pacific Islander
	Southeast Asia
	White, European-American
	Other

Sacraments received

	Baptism
	First Communion
	Confirmation

HELP US GET TO KNOW YOU BETTER

Which weekend Mass do you typically attend?

Sat 5:00 PM

Sun 11:00 AM

I need information about?

	Baptism
	RCIA (Rite of Christian Initiation for Adults)
	Children's Faith Formation

	Youth Ministry
	Marriage
	Annulments

I'd like to get involved or would like more information.