St. Barnabas Parish Registration Form
Welcome to our family! Please complete the form below so that we can get to know you! Once completed, we will send you more information about our parish by your preferred form of contact.
Family Name
*
Last Name
Address
*
Street Address
Street Address Line 2
City
State
Zip Code
Primary Phone Number
*
Phone Number Type
*
Please Select
Cell
Home
Work
Other
Unlisted?
*
Yes
No
Additional Phone Number (in case of an emergency)
Phone Number Type
Please Select
Cell
Home
Work
Other
Email
*
example@example.com
Preferred Form of Contact
*
Please Select
Email
Text Message
Phone Call
Mail
Marital Status:
*
Married
Single
Widowed
Separated
Divorced
Place of Marriage (Church Name/Other Location)
*
City/State
*
Please Select One of the Following:
*
Priest
Minister
Civil
Can we list you in the bulletin as a new member?
*
YES
NO
Family Member 1
First Name
*
Middle Name
*
Maiden Name (indicate N/A if not applicable)
*
Date of Birth
*
-
Month
-
Day
Year
Religion
Please Select
Roman Catholic
Protestant
Orthodox such as Greek or Russian Orthodox
Jewish
Muslim
Buddhist
Hindu
Other
If not Catholic, are you interested in becoming Catholic?
Yes
No
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
None
Occupation
*
Place of Employment
*
Do you have children living in your home?
*
Yes
No
Spouse
Spouse's First Name
*
Spouse's Middle Name
Spouse's Maiden Name (indicate N/A if not applicable)
*
Spouse's Email
example@example.com
Spouse's Primary Phone Number
*
Spouse Date of Birth
*
-
Month
-
Day
Year
Date
Spouse Religion
*
Spouse Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
None
Spouse Occupation
*
Spouse Place of Employment
*
Children Living At Home
How many children are living in your home?
*
Please Select
One
Two
Three
Four
Five
Six
Seven
Eight
Nine
Ten
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Child's First and Last Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Month
-
Day
Year
Date
Sacraments received (if applicable)
*
Baptism
Eucharist
Confirmation
Married
None
Present Grade & School
*
Do you have other people living in your home with you?
*
Yes
No
Other Individuals Living In Your Home
(If they would also like to register, please fill out a separate registration form)
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to you
Religion
Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Relationship to you
Religion
Ministries
Please list any parish ministries you might know of and want to get involved with or what talents you would like to share with the parish community.
Thank you for taking the time to complete this form. A staff member will reach out to you within a few weeks, but feel free to contact the Parish Office at (330) 467-7959 or at parishoffice@barnabasohio.org if you have any questions before then.
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