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St. Teresa of Avila Registration Form
Please fill in the form below and be sure to "submit" at the end. Thank you!
Family Information
Family Name
*
Please enter last name of family.
Home Phone
*
If none, your primary contact number
Home Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Parishioner Status
*
New Member
Existing Member
We are no longer parishioners
Previous Parish Name/City/State
For New Members
Mass most likely to attend at St. Teresa (for Sunday Obligation) if "Other", please list church name and time
Saturday 3:30 PM
Sunday 9:00 AM
Other
How often do you attend Mass?
Weekly
Bi-Monthly
Monthly
2 times year
Prefer not to answer
Other
Envelope Number
For current parishioners
Do you prefer to contribute to the parish through:
*
Weekly envelopes
ACH Electronic withdrawal weekly or monthly
Credit Card options available on Website
Other
Household type:
Single Family
Single Adult
Single Parent
Widow/Widower
Blended Family
Extended Family (other adults living in the same household, adult children, elderly parents/relatives, relatives)
Other
Language(s) Spoken in the Home
*
Does anyone in the family have a disability?
Please list names and disability (ie: Autism, Downs Syndrome, wheelchair bound, etc.)
Is anyone in the home an alumni of St. Teresa School? Please list name and year of graduation.
Please list name(s) and year of graduation.
Do you have any children aged 5-14?
*
Yes
No
If yes, are they registered/ing for PSR? (Parish School of Religion for the Region is held at St. Teresa of Avila on Sundays)
Yes
Contact Me
No
Please send me information on St. Teresa School
Yes
No
Head of Household
Full Name
*
Mr.
Mrs.
Ms.
Dr.
Rev.
Dcn.
Br.
Sr.
Prefix
First Name
Middle Name
Last Name
Nickname
If applicable
Maiden Name
If applicable
Gender
Male
Female
Marital Status
*
Please Select
Single
Married
Widowed
Separated
Divorced
Married in the Catholic Church?
Yes
No
Anniversary Date
/
Month
/
Day
Year
E-mail
*
If none, type none@none.com
Mobile Phone
Best Way(s) to Reach You
*
Home Phone
Mobile Phone
Email
Text to Mobile Phone
Occupation
If retired, prior primary occupation
Employer
Work Phone
Birth Date
*
/
Month
/
Day
Year
Mother's Maiden Name
Used to track Sacraments
Baptized?
*
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
Confirmation?
*
Yes
No
Unkown
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
RCIA Church/Location
Your Religion (if not Catholic)
Spouse
Full Name
Mr.
Mrs.
Ms.
Dr.
Rev.
Prefix
First Name
Middle Name
Last Name
Nickname
If applicable
Maiden Name
If applicable
Gender
Male
Female
E-mail
Mobile Phone
Best Way(s) to Reach You
Home Phone
Mobile Phone
Email
Text to Mobile Phone
Occupation
If retired, prior primary occupation
Employer
Work Phone
Birth Date
/
Month
/
Day
Year
Mother's Maiden Name
Used to track Sacraments
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
Confirmation?
Yes
No
Unkown
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
RCIA Church/Location
Your Religion (if not Catholic)
Children (Living at home)
Children over the age of 25 (or over age 25 and in a separate residence) should register with the parish on their own. This is essential for our ability to assist them with their sacramental needs or if they are asked to be a godparent, or sacramental sponsor. Other household members over the age of 25 should also register separately.
Child #1
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
Grade in School
Please Select
Pre-K age 3
Pre-K age 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
School
Please Select
St. Teresa School
Covedale
Carson
Elder High School
Seton High School
West High
Oak Hills High School
Home-schooled
Other Catholic K-12 School
Other Cincinnati K-12 School
College
Other
None
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
First Eucharist?
Yes
No
Church and City of First Eucharist
Confirmation?
Yes
No
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
Current Religion (if not Catholic)
Child #2
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
School
Please Select
St. Teresa School
Covedale
Carson
Elder High School
Seton High School
West High
Oak Hills High School
Home-schooled
Other Catholic K-12 School
Other Cincinnati K-12 School
College
Other
None
Grade in School
Please Select
Pre-K 3
Pre-K 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
First Eucharist?
Yes
No
Church and City of First Eucharist
Confirmation?
Yes
No
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
Current Religion if not Catholic
Child #3
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
School
Please Select
St. Teresa School
Covedale
Carson
Elder High School
Seton High School
West High
Oak Hills High School
Home-schooled
Other Catholic K-12 School
Other Cincinnati K-12 School
College
Other
None
Grade in School
Please Select
Pre-K age 3
Pre-K age 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
First Eucharist?
Yes
No
Church and City of First Eucharist
Confirmation?
Yes
No
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
Current Religion (if not Catholic)
Child #4
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
School
Please Select
St. Teresa School
Covedale
Carson
Elder High School
Seton High School
West High
Oak Hills High School
Home-schooled
Other Catholic K-12 School
Other Cincinnati K-12 School
College
None
Grade in School
Please Select
Pre-K age 3
Pre-K age 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
First Eucharist?
Yes
No
Church and City of First Eucharist
Confirmation?
Yes
No
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
Current Religion (if not Catholic)
Child #5
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
School
Please Select
St. Teresa School
Covedale
Carson
Elder High School
Seton High School
West High
Oak Hills High School
Home-schooled
College
Other
None
Grade in School
Please Select
Pre-K 3
Pre-K 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
First Eucharist?
Yes
No
Church and City of First Eucharist
Confirmation?
Yes
No
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
Current Religion (if not Catholic)
Child #6
Full Name
First Name
Full Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birthday
-
Month
-
Day
Year
Date
School
St. Teresa School
Covedale
Carson
Elder High School
Seton High School
West High
Oak Hills High School
Home-schooled
College
Other
None
Grade in School
Pre-K 3
Pre-K 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
Baptized?
Yes
No
As Catholic?
Yes
No
Church and City of Baptism
First Eucharist?
Yes
No
Church and City of First Eucharist
Confirmation?
Yes
No
Church and City of Confirmation
Rite of Christian Initiation for Adults (RCIA) participant present or past?
Yes
No
Current Religion (if not Catholic)
If not Catholic
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INVOLVEMENT IN THE CHURCH
Liturgical Ministry
Adult Choir
Wish to Join
Already Joined
Name(s)
Enter names of participants
Altar Server (adult or youth)
Wish to Join
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Name(s)
Enter names of participants
Art & Environment
Wish to Join
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Name(s)
Enter names of participants
Bereavement
Wish to Join
Already Joined
Name(s)
Enter details here.
Communion to the Homebound
Wish to Join
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Name(s)
Enter details here.
Eucharistic Minister
Wish to Join
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Name(s)
Enter names of participants
Greeter
Wish to Join
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Name(s)
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Lector
Wish to Join
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Name(s)
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Sacristan and/or Assistant
Wish to Join
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Name(s)
Enter names of participants
Men's Prayer Group
Wish to Join
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Name(s)
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Respect Life Committee
Wish to Join
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Name(s)
Enter details here.
St. Vincent de Paul Society
Wish to Join
Already Joined
Name(s)
Enter details here.
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Liturgical Ministries
Hospital & Homebound Visits
Wish to Join
Already Joined
Name(s)
Enter names of participants
Usher
Wish to Join
Already Joined
Names
Enter names of participants
Wedding Facilitator
Wish to Join
Already Joined
Name(s)
Enter names of participants
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Organizations
Athletic Association
Wish to Join
Already Joined
Name(s)
Enter names of participants
Grounds Beautification
Wish to Join
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Name(s)
Enter names of participants
Education Commission (elected)
Wish to run
Already aboard
Name(s)
Enter names of participants
Finance (appointed)
Wish to Join
Already Joined
Name(s)
Enter names of participants
Pastoral Council (elected)
Wish to Run
Already aboard
Name(s)
Enter names of participants
Worship Commission
Wish to Join
Already Joined
Name(s)
Enter names of participants
Youth Group Leader (Virtus required)
Wish to Join
Already Joined
Name(s)
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Religious Education
PSR Instructor/ Catechist
Wish to Join
Already Joined
Name(s)
Enter names of participants
RCIA Sponsor
Wish to Join
Already Joined
Name(s)
Enter names of participants
RCIA Volunteer
Wish to Join
Already Joined
Name(s)
Enter names of participants
Technology & Communications
Bulletin Inserts
Wish to Join
Already Joined
Name(s)
Enter names of participants
Photography
Wish to Join
Already Joined
Name(s)
Enter names of participants
Activities & Fundraising
Bingo Volunteer
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Name(s)
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Festival Committee
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Name(s)
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Festival Volunteer
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Name(s)
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Parish Picnic Volunteer
Wish to Join
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Name(s)
Enter names of participants
School Volunteer (Virtus required)
Wish to Join
Already Joined
Name(s)
Enter names of participants
Parish Directory Authorizations
Publish Phone Number?
*
Yes
No
Publish Address?
*
Yes
No
Publish Email?
*
Yes
No
Add to list to receive EMAIL messages from parish?
*
Yes
No
Add to list to receive TEXT messages from parish?
*
Yes
No
Submit
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