Parish Registration Form
Date
-
Month
-
Day
Year
Date
For office user only: Envelope #
Mailing Name
e.g. Mr. and Mrs. John Doe
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
-
Area Code
Phone Number
Home Phone
-
Area Code
Phone Number
Emergency Phone
-
Area Code
Phone Number
Primary Email
example@example.com
Marital Status
single, married, separated, divorced, annulled, widowed
Wedding Date
-
Month
-
Day
Year
Date
Permission to publish phone and address in Parish Directory?
Yes
No
Offertory Pledge
Frequency
per week
per month
per year
Individual Member Information
Role
e.g. head of house, husband, wife, etc.
Name
First Name
Last Name
Maiden Name
Gender
Male
Female
Cell Phone
-
Area Code
Phone Number
Email
example@example.com
Birthdate
-
Month
-
Day
Year
Date
Special Needs
First Language
Second Language?
Occupation
Ethnicity
Sacramental Info
Baptism Date
-
Month
-
Day
Year
Date
Religion When Baptized
First Eucharist
-
Month
-
Day
Year
Date
Confirmation
-
Month
-
Day
Year
Date
Individual Member Information
Spouse if applicable
Role
e.g. head of house, husband, wife, etc.
Name
First Name
Last Name
Maiden Name
Gender
Male
Female
Cell Phone
-
Area Code
Phone Number
Email
example@example.com
Birthdate
-
Month
-
Day
Year
Date
Special Needs
First Language
Second Language?
Occupation
Ethnicity
Sacramental Info
Baptism Date
-
Month
-
Day
Year
Date
Religion When Baptized
First Eucharist
-
Month
-
Day
Year
Date
Confirmation
-
Month
-
Day
Year
Date
Dependent Children Information
Submit
Should be Empty: