Parish Registration Form
Welcome to St. Benedict Parish! We are very happy that you wish to become part of our parish family. Please take a few minutes to complete this form. All information provided is strictly confidential and is used solely for the provision of pastoral care to registered members of the parish. It is not used for any commercial purposes.
General Information
Family Name
*
Registrant
*
Given Name(s)
Surname
Joint Registrant
Given Name(s)
Maiden Surname
Surname
Marital Status
*
Please Select
Married in a Roman Catholic Church
Married in a Non Catholic Church
Civil Marriage
Second Marriage for Male
Second Marriage for Female
Widowed
Separated
Divorced
Declaration of Nullity for Male
Declaration of Nullity for Female
Common Law/Cohabitation
Never Married (Single)
Select what applies to your current marriage.
Church of Marriage
Date of Marriage
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Please select if applicable
I would like to discuss our marriage situation with a priest
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Family Information
Please complete the following information about yourself and all other members of your household.
Registrant
Name
*
First Name
Last Name
Gender
*
Male
Female
Date of Birth
*
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
*
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
Occupation
*
Joint Registrant
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
Occupation
Child/Young Adult #1
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
School
Guardian Angels
Our Lady of Fatima
Lumen Christi
St. Benedict
St. Scholastica
St. Francis Xavier HS
St. Kateri Tekakwitha HS
Other (please specify)
Child/Young Adult #2
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
School
Guardian Angels
Our Lady of Fatima
Lumen Christi
St. Benedict
St. Scholastica
St. Francis Xavier HS
St. Kateri Tekakwitha HS
Other (please specify)
Child/Young Adult #3
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
School
Guardian Angels
Our Lady of Fatima
Lumen Christi
St. Benedict
St. Scholastica
St. Francis Xavier HS
St. Kateri Tekakwitha HS
Other (please specify)
Child/Young Adult #4
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
School
Guardian Angels
Our Lady of Fatima
Lumen Christi
St. Benedict
St. Scholastica
St. Francis Xavier HS
St. Kateri Tekakwitha HS
Other (please specify)
Child/Young Adult #5
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
School
Guardian Angels
Our Lady of Fatima
Lumen Christi
St. Benedict
St. Scholastica
St. Francis Xavier HS
St. Kateri Tekakwitha HS
Other (please specify)
Child/Young Adult #6
Name
First Name
Last Name
Gender
Male
Female
Date of Birth
-
Day
-
Month
Year
2 digit day, 2 digit month, 4 digit year
Religion
Please Select
Roman Catholic
Eastern Rite Catholic
Orthodox
Non-Catholic Christian
Unbaptized
School
Guardian Angels
Lumen Christi
Our Lady of Fatima
St. Benedict
St. Josephine Bakhita
St. Scholastica
St. Veronica
St. Francis Xavier HS
St. Kateri Tekakwitha HS
Other (please specify)
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Family Contact Information
Email Address
*
Phone Number
*
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal Code
Would you like to receive offering envelopes as a means of supporting the parish?
Yes
No
Would you like to use Pre-Authorized Debit to support the parish?
Yes
No
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