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Parish Registration

Become a Member!
complete and submit this form
to Request a registration Packet
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  Have you registered with us before? REQUIRED Yes No Please fill out this field.
  
  Wife's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Language/Secondary Language REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation Please enter valid data.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Baptized REQUIRED Please fill out this field.
  
  First Communion REQUIRED Please fill out this field.
  
  Confirmation REQUIRED Please fill out this field.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Husband's Information
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Language/Secondary Language REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation Please enter valid data.
  
  Sex REQUIRED Please fill out this field.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Baptized REQUIRED Please fill out this field.
  
  First Communion REQUIRED Please fill out this field.
  
  Confirmation REQUIRED Please fill out this field.
  
  Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Home Address
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  How would you prefer to financially support the parish? REQUIRED Please fill out this field.
  
  Children's Information
  
  Children in Household REQUIRED Please fill out this field.
  
  Child 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 5
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 6
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 7
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 8
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 9
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
  Child 10
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birthdate Please enter a date.
  
  Sacraments Received Please enter valid data.
  
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