Parish Registration

Parish (select one) REQUIRED Please fill out this field.

Family Name REQUIRED Please fill out this field. Please enter valid data.

Phone REQUIRED Please fill out this field. Please enter valid data.

Street 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.

Marital Status REQUIRED Please fill out this field.

If other, please specify: Please enter valid data.

Marriage witnessed by a Catholic Priest Yes No

E-mail Address REQUIRED Please fill out this field. Please enter valid data.

Parish Registration / Census Data

Adult #1

Title/First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
Birthdate REQUIRED Please fill out this field. Please enter a date.
Gender REQUIRED Please fill out this field.
Religion REQUIRED Please fill out this field. Please enter valid data.
Baptized REQUIRED Please fill out this field.
First Communion REQUIRED Please fill out this field.
Confirmed REQUIRED Please fill out this field.
Education Completed
(Optional)
High School College Graduate Degree Post-Graduate
Occupation Please enter valid data.
Employer Please enter valid data.

Adult #2

First/Middle/Last Name Please enter valid data.
Birthdate Please enter a date.
Gender
Religion Please enter valid data.
Baptized
First Communion
Confirmed
Education Completed
(Optional)
High School College Graduate Degree Post-Graduate
Occupation Please enter valid data.
Employer Please enter valid data.

Child Dependent #1

Please let us know the current education level for your child. ( i.e., Pre-school, Elementary, Middle, High)

Education Level Please enter valid data.

Child Dependent #2

First/Middle/Last Name Please enter valid data.
Birthdate Please enter a date.
Gender
Religion Please enter valid data.
Baptized
First Communion
Confirmed
Please let us know the current education level for your child. ( i.e., Pre-school, Elementary, Middle, High)
Education Level Please enter valid data.

Child Dependent #3

First/Middle/Last Name Please enter valid data.
Birthdate Please enter a date.
Gender
Religion Please enter valid data.
Baptized
First Communion
Confirmed
Please let us know the current education level for your child. ( i.e., Pre-school, Elementary, Middle, High)
Education Level Please enter valid data.

Child Dependent #4

First/Middle/Last Name Please enter valid data.
Birthdate Please enter a date.
Gender
Religion Please enter valid data.
Baptized
First Communion
Confirmed
Please let us know the current education level for your child. ( i.e., Pre-school, Elementary, Middle, High)
Education Level Please enter valid data.