Join Us! 33%Parish Registration Form Date Registering:Family Name*Address*City*State*Please selectWisconsinAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWyomingZip Code*Primary Phone Number:*Type:HomeMobileAlternate Number:Type:HomeMobileEmail address*Send Email Instead of Mail, When Possible.YesNoPlease Do NOT Share My Personal Information.Do Not SharePermission is granted to use photos taken of me or my family on parish-based communication platforms.YesNo Head of Household / Primary Adult Member Information Name:*Please selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixBirth Date:Gender:MaleFemaleMarital Status (Choose One):EngagedMarriedSeparatedDivorcedSingleSingle with Child(ren)WidowWidowerEthnicity (Choose One):African AmericanAsianHispanic or LatinoNative AmericanPacific IslanderWhiteEmail address:Language:(Indicate if other than English)Religion:CatholicChristianLutheranMethodistPenecostalPresbyterianNon-CatholicNon-DenominationalOtherSacraments (Check All that Apply):BaptismCommunionConfirmationOccupation:Next Spouse/Second Adult Member Information Is there a second adult household member?YesNoName:Please selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixBirth Date:Gender:MaleFemalePrimary Phone Number:Type:HomeMobileAlternate Number:Type:HomeMobileMarital Status (Choose One):EngagedMarriedSeparatedDivorcedSingleSingle with Child(ren)WidowWidowerEthnicity (Choose One):African AmericanAsianHispanic or LatinoNative AmericanPacific IslanderWhiteLanguage:(Indicate if other than English)Religion:CatholicChristianLutheranMethodistPenecostalPresbyterianNon-CatholicNon-DenominationalOtherOccupation:BackNext Children / Dependents in Your Household How many children or dependents do you have in your household?Please select012345678910 First Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Second Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Third Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Fourth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Fifth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Sixth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Seventh Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Eighth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Ninth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Tenth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmationBackSendThis field should be left blank
