Parish Registration Form

Member 5 Gender*

MaleFemale

Member 5 Full Name*

TitleFirst NameMiddle NameLast NameSuffix

Member 5 Nickname

Member 5 Maiden Name

Member 5 Role in Household*

Member 5 Date of Birth*

MonthDayYear

Member 5 Place of Birth*

Street Address

Street Address Line 2

CityState / Province

Country

Member 5 Religion*

Member 5 Primary Language*

EnglishSpanishOther

Member 5 Ethnicity

Member 5 Marital Status*

What is your most preferred method of communication?*

EmailPhone CallText Message

Member 5 Special Needs

Member 5 Father's Full Name

First NameLast NameSuffix

Member 5 Mother's Full Name

First NameMiddle NameMaiden NameMarried Name

Member 4 Occupation

Member 5 School

School Name

Street Address

CityState / Province

Postal / Zip Code

Member 5 Grade

Member 5 Email*

example@example.com

Member 5 Cell Phone*

Area CodePhone Number

Member 5 Sacraments (check all that apply)*

Which Ministries are you interested in being more involved?

Liturgical Ministry (Altar Server, Lector, EM Holy Communion, Choir, etc.)Faith Formation (RCIA, Sacramental Prep, Youth Ministry, Bible Study, etc.)Charity & Outreach (St. Vincent de Paul, Presbyterian Night Shelter, Knights of Columbus, etc.)Administration (Phones, Data Entry, Counting Offertory, etc.)

Would you like to a add a 6th Member?

YesNo

Parish Registration Form

Family Information

Member 1 Information