Parish Registration Form
Name
*
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Unlisted?
yes
no
Spouse
First Name
Last Name
Birth Date
-
Month
-
Day
Year
Date
Email
example@example.com
Phone Number
Please enter a valid phone number.
Unlisted?
yes
no
If maiden name of spouse is to be included on mailing label, please indicate:
(maiden name)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Mass attended
Saturday 5:00 pm
Sunday 10:00 am
Sunday 12:00 noon
Sunday 7:00 pm
Number of children at home?
Home visit requested?
*
yes
no
How would you prefer to support the parish financially?
*
Envelopes
Pre-Authorized Giving Program (Pre-authorized debit -- PAD)
Loose and/or occasional donation in Sunday Collection, or e-transfer
Comments?
Submit
Should be Empty: