• New Parishioner Registration

  St. Peter Chanel Catholic Church
• Family Last Name:*
• Registrant Formal First Name & MI:*
• Gender:
  MaleFemale
• Preferred Name:
• Spouse's Formal First Name & MI:
• Preferred Name:
• Marital Status:
  Please Select Single Married Divorced Marriage Annulled Widowed
• Street Address:*
• Subdivision:
• City:*
• Zip Code:*
• Primary Phone Number:*
  Please enter a valid phone number.
• Previous Parish Registration:
• City/State:
• Back

  Next

• Personal Information - Registrant

• Registrant Title:*
  Please Select Mr. Mrs. Ms. Miss Dr.
• Date of Birth:*
   -Month -DayYear

  Date
• Roman Catholic?:
  YesNo
• Other Denomination
• Sacraments Received:
  BaptismCommunionConfirmationMarriage
• Marriage Date:
• Cell Phone Number:*
  Please enter a valid phone number.
• Email:*
  example@example.com
• Occupation:
• Employer Name:
• Work Phone:
  Please enter a valid phone number.
• Back

  Next

• Personal Information - Spouse

• Spouse Title:
  Please Select Mr. Mrs. Ms. Miss Dr.
• Spouse Date of Birth:
   -Month -DayYear

  Date
• Spouse Roman Catholic:*
  YesNo
• Other Denomination:
• Spouse Sacraments Received:
  BaptismCommunionConfirmation
• Spouse Cell Phone Number:
  Please enter a valid phone number.
• Spouse Email:
  example@example.com
• Spouse Occupation:
• Spouse Employer Name:
• Spouse Work Phone Number:
  Please enter a valid phone number.
• Back

  Next

• Do you have Dependent Children living at home?:
  yesno
• First Name, MI (and Last Name if different):
• Nickname:
• Date of Birth:
   -Month -DayYear

  Date
• Gender:
  MaleFemale
• Grade:
• Date of Baptism:
   -Month -DayYearDate Picker Icon
• Date of Communion:
   -Month -DayYearDate Picker Icon
• Date of Confirmation:
   -Month -DayYear

  Date
• Please note any special needs (i.e. physically challenged, shut-in, etc.):
• Add Child 2?:
  YesNo
• First Name Child 2, MI (and Last Name if different):
• Nickname Child 2:
• Date of Birth Child2:
   -Month -DayYear

  Date
• Gender Child 2:
  MaleFemale
• Grade Child 2:
• Date of Baptism Child 2:
   -Month -DayYear

  Date
• Date of Communion Child 2:
   -Month -DayYear

  Date
• Date of Confirmation Child 2:
   -Month -DayYear

  Date
• Please note any special needs (i.e. physically challenged, shut-in, etc.) Child 2:
• Back

  Next

• Add Child 3?:
  YesNo
• First Name Child 3, MI (and Last Name if different):
• Nick Name Child 3:
• Date of Birth Child 3:
   -Month -DayYear

  Date
• Gender Child 3:
  MaleFemale
• Grade Child 3:
• Date of Baptism Child 3:
   -Month -DayYear

  Date
• Date of First Communion Child 3:
   -Month -DayYear

  Date
• Date of Confirmation Child 3:
   -Month -DayYear

  Date
• Please note any special needs (i.e. physically challenged, shut-in, etc.) Child 3:
• Back

  Next

• Add Child #4?:
  YesNo
• First Name Child 4, MI (and Last Name if different):
• Nick Name Child 4:
• Date of Birth Child 4:
   -Month -DayYear

  Date
• Gender Child 4:
  MaleFemale
• Grade Child 4:
• Date of Baptism Child 4:
   -Month -DayYear

  Date
• Date of Communion Child 4:
   -Month -DayYear

  Date
• Date of Confirmation Child 4:
   -Month -DayYear

  Date
• Please note any special needs (i.e. physically challenged, shut-in, etc.) Child 4:
• Back

  Next

• Add Child #5?
  YesNo
• First Name Child 5, MI (and Last Name if different):
• Nick Name Child 5:
• Date of Birth Child 5:
   -Month -DayYear

  Date
• Gender Child 5:
  MaleFemale
• Grade Child 5:
• Date of Baptism Child 5:
   -Month -DayYear

  Date
• Date of Communion Child 5:
   -Month -DayYear

  Date
• Date of Confirmation Child 5:
   -Month -DayYear

  Date
• Please note any special needs (i.e. physically challenged, shut-in, etc.) Child 5:
• Back

  Next

• Emergency Contact Name:
• Relationship:
• Telephone Number:
  Please enter a valid phone number.
• Do you wish to receive the Archdiocesan newspaper (The Georgia Bulletin)?:*
  YesNo
• Do you wish to receive news/updates from SPC via email?:*
  YesNo
• May we publish your contact information?:*
  YesNo
• Submit
• Should be Empty: