Registration Form to download and mail to the Parish office Download Online Fillable Form Date* MM slash DD slash YYYY Family Name Address* Street Address Address Line 2 City ZIP Code Cell #*Email Do you want to receive Faith Magazine? Yes No Do you want to receive contribution envelopes? Yes No Permission to publish phone, address and email in Parish Directory Phone Address Email I do not want anything published Head of HouseholdMarital Satus* Single Married Widow Widower Divorced Marriage Civil Canonical Convalidation Wedding Anniversary date Wedding Location City State 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 Name* First Last Nickname Date of Birth* Home Phone #Sacraments Received*Please check if received Baptism First Communion Confirmation None of the above Dates and locations of sacraments receivedInput Spouse or Household Member Information?*Please note – You must include your spouse’s information if you would like them included on the account. Yes No Spouse InformationName* First Last Nick Name Maiden Name Cell #*Date of Birth* Sacraments Received*Please check if received Baptism First Communion Confirmation None of the above Dates and locations of sacraments receivedOccupation* General InformationAdditional Household Members?* Yes No Additional Household MembersName* First Last Relationship* Birth Date* MM slash DD slash YYYY Sacraments ReceivedPlease check if received Baptism First Communion Reconciliation Confirmation Additional Member* Yes No Additional Family Member 2Name* First Last Relationship* Birth Date* MM slash DD slash YYYY Sacraments ReceivedPlease check if received Baptism First Communion Reconciliation Confirmation Additional InformationAre there homebound members who are prevented from attending mass?* Yes No Additional Information you would like to addEmergency Contact Outside of HouseholdName* First Last Relationship* City* State* Emergency Contact Phone Number*NameThis field is for validation purposes and should be left unchanged.