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Registration Form
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Saturday Evening, 6.30pm
Sunday Morning St. Patrick's, 9:30am
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Birth Date
*
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Month
/
Day
Year
Mother's Maiden Name
Used to track Sacraments
Baptised?
*
Yes
No
As Catholic?
*
Yes
No
First Reconciliation?
*
Yes
No
First Eucharist?
*
Yes
No
Confirmation?
*
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
Spouse
Full Name
Mr.
Mrs.
Ms.
Dr.
Rev.
Prefix
First Name
Middle Name
Last Name
Nickname
If applicable
Maiden Name
If applicable
Mobile Phone
E-mail
Birth Date
/
Month
/
Day
Year
Mother's Maiden Name
Used to track Sacraments
Baptised?
Yes
No
As Catholic?
Yes
No
First Reconciliation?
Yes
No
First Eucharist?
Yes
No
Confirmation?
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
Children (Living at home)
Child #1
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
Baptised?
Yes
No
As Catholic?
Yes
No
First Reconciliation?
Yes
No
First Eucharist?
Yes
No
Confirmation?
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
Child #2
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
Baptised?
Yes
No
As Catholic?
Yes
No
First Reconciliation?
Yes
No
First Eucharist?
Yes
No
Confirmation?
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
Child #3
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
School
Please Select
St. Albert School System
Heartland Christian School System
Bloomer Elementary
Carter Lake Elementary
College View Elementary
Crescent Elementary
Edison Elementary
Franklin Elementary
Hoover Elementary
Kreft Primary
Lewis & Clark Elementary
Longfellow Elementary
Roosevelt Elementary
Rue Elementary
Titan Hill Intermediate
Kirn Middle School
Lewis Central Middle School
Wilson Middle School
Abraham Lincoln High School
Kanesville Alternative Learning
Lewis Central High School
Thomas Jefferson High School
Treynor Community School District
Underwood Community School District
Glenwood Community School District
Missouri Valley School District
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Year in School
Please Select
Pre-K 3
Pre-K 4
K
1
2
3
4
5
6
7
8
9
10
11
12
College
Baptised?
Yes
No
As Catholic?
Yes
No
First Reconciliation?
Yes
No
First Eucharist?
Yes
No
Confirmation?
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
Child #4
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
Baptised?
Yes
No
As Catholic?
Yes
No
First Reconciliation?
Yes
No
First Eucharist?
Yes
No
Confirmation?
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
Child #5
Full Name
First Name
Middle Name
Last Name
Nickname
If applicable
Gender
Male
Female
Birth Date
/
Month
/
Day
Year
Baptised?
Yes
No
As Catholic?
Yes
No
First Reconciliation?
Yes
No
First Eucharist?
Yes
No
Confirmation?
Yes
No
RCIA?
Yes
No
Current Religion
What year?
About what year?
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Legion of Mary
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Society of St Vincent de Paul
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