REGISTRATION FORM
Saint Mary Catholic Church, FWB
Date
/
Month
/
Day
Year
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Previous Parish
Parish Name, Zip Code
How many Head(s) of Household?
*
1
2
How many children living with you to register?
*
0
1
2
3
4
5
6
Other Adults(19yrs old+) living with you
*
0
1
2
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Head(s) of Household
HoH #1
*
Title
First Name
Middle Name
# 1 Last Name
Religion
*
Baptized?
*
Please Select
Yes
No
Received 1st Confession?
*
Please Select
Yes
No
Received 1st Communion?
*
Please Select
Yes
No
Confirmed?
*
Please Select
Yes
No
Gender
*
Please Select
Female
Male
Date of Birth
*
/
Month
/
Day
Year
Date
Place of Birth
*
City, State or Country
Marital Status
*
Please Select
Married
Single
Divorce
Separated
Widowed
Partnered
Date Married
*
/
Month
/
Day
Year
Date
Married by Catholic Priest or Deacon?
*
Please Select
Yes
No
Primary Phone
*
Email Address
*
example@example.com
Occupation
Work Phone Number
Please enter a valid phone number.
Active Duty or Retired Military?
Please Select
Active Duty
Retired Military
N/A
Head of Household #2 Info
Head of Household #2
*
Title
First Name
Middle Name
# 2 Last Name
Religion
*
Baptized?
*
Please Select
Yes
No
Received 1st Confession?
*
Please Select
Yes
No
Received 1st Communion
*
Please Select
Yes
No
Received Confirmation?
*
Please Select
Yes
No
Gender
*
Please Select
Female
Male
Date of Birth
*
/
Month
/
Day
Year
Date
Place of Birth
Marital Status
*
Please Select
Married
Single
Divorce
Separated
Widowed
Partnered
Date Married
*
/
Month
/
Day
Year
Date
Married by Catholic Priest or Deacon?
*
Please Select
Yes
No
Primary Phone
*
Email Address
*
example@example.com
Occupation
Work Phone
Active Duty or Retired Military?
Please Select
Active Duty
Retired Military
N/A
Child #1 Info
Child #1
*
First Name
Middle Name
Last Name
Son or Daughter
*
Please Select
Son
Daughter
Religion
*
Date of Birth
*
/
Month
/
Day
Year
Date
Place of Birth
*
City, State or Country
School Attending
*
Baptized?
*
Please Select
Yes
No
Received 1st Confession?
*
Please Select
Yes
No
Received 1st Communion?
*
Please Select
Yes
No
Confirmed?
*
Please Select
Yes
No
Child #2 Info
Child #2
First Name
Middle Name
Last Name
Son or Daughter?
Please Select
Son
Daughter
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
School Attending
Baptized?
Please Select
Yes
No
Received 1st Confession?
Please Select
Yes
No
Received 1st Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
Child #3 Info
Child #3
First Name
Middle Name
Last Name
Son or Daughter?
Please Select
Son
Daughter
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
School Attending
Baptized?
Please Select
Yes
No
Received 1st Confession?
Please Select
Yes
No
Received 1st Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
Child #4 Info
Child #4
First Name
Middle Name
Last Name
Son or Daughter?
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
School Attending
Baptized?
Please Select
Yes
No
Received 1st Confession?
Please Select
Yes
No
Received 1st Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
Child #5 Info
Child #5
First Name
Middle Name
Last Name
Son or Daughter?
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
School Attending
Baptized?
Please Select
Yes
No
Received 1st Confession?
Please Select
Yes
No
Received 1st Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
Child #6 Info
Child #6
First Name
Middle Name
Last Name
Son or Daughter?
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
School Attending
Baptized?
Please Select
Yes
No
Received 1st Confession?
Please Select
Yes
No
Received 1st Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
Additional Adult #1 Info
Additional Adult #1
First Name
Middle Name
Last Name
Relationship to head(s) of household?
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
Phone
Occupation
Baptized?
Please Select
Yes
No
Received 1st Confession
Please Select
Yes
No
Received 1st Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
Additional Adult #2 Info
Additional Adult #2
First Name
Middle Name
Last Name
Relationship to head(s) of household?
Religion
Date of Birth
/
Month
/
Day
Year
Date
Place of Birth
Phone
Occupation
Baptized?
Please Select
Yes
No
Received 1st Confession?
Please Select
Yes
No
Received 1 Communion?
Please Select
Yes
No
Confirmed?
Please Select
Yes
No
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Person to Contact in Case of Emergency:
Name
*
Phone
*
Relationship
*
Signature
*
Please initialize that the information is correct.
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