St. Agnes & Our Lady of Fatima RCIA Inquirer Form

St. Agnes and Our Lady of Fatima Parish
Rite of Christian Initiation(RCIA) Inquirer Information Request Form
NOTE: Information provided here is held in confidence and is not shared without your permission except among parish clergy and staff.
Are you seeking information..? (Please select all that apply)*

for yourself?on behalf of another adult(18 years of age or older)?for a child(ages 7 to 12)?for a teenager(ages 13-17)?for 2 or more people?
Today’s Date:

MonthDayYear
Date
I. Contact Information
Name*

First NameLast Name
Mailing Address:
Apt:
(Apt, Suite, etc)
City:
State:
Zip:
Phone: (Daytime)

Area CodePhone Number
Phone: (Evening)

Area CodePhone Number
Mobile:

Area CodePhone Number
E-mail:
example@example.com
Preferred Contact Option(s)

Phone(Daytime)Phone(Evening)MobileEmailOther
If you prefer contact by mobile, briefly indicate the best day(s) and time(s) to reach you:
Should be Empty:

St. Agnes and Our Lady of Fatima Parish