St. John Nepomuk Catholic Church Parish Registration Form

St. John Nepomuk Catholic Church Parish Registration Form
Name*

First NameFamily Last Name
Today's Date*

MonthDayYear
Date
Mailing Address*
City*
Apt.#
Zip.*
E mail Address (es)*
example@example.com
Marriage Status*

SingleMarriedDivorcedWidowed
Date of Marriage

MonthDayYear
Date
Check all that apply:

Civil MarriageCatholic MarriageConvalidation
If Catholic Marriage/Convalidation, complete the following:
Performed by
Church Name
Church City/State/Country
How would you like to give to the Church?

Monthly Giving EnvelopesWeShare Online GivingACH Monthly Bank Draft
Select if you need any help with Sacrament Preparation?

Baptism1st CommunionReconciliationConfirmationMarriage/ConvalidationAnnulmentDiscerning Religious Vocation
Select any ministries you are interested in

Children RE ( Pre-K4—5th)1/2 TYME (6th—8th grade)TYME (9th—12th grade)Adult REInquiryRCIA/RCICLectorAltar ServerUsher/GreeterChoirInstrumentalistCatechistKnights of ColumbusK of C Ladies AuxiliaryAltar SocietyGolden SagersRosaryMen’s MinistryYoung Adult MinistryMother's MinistryBoy ScoutsGardening AngelsRCIA SponsorMarriage Sponsor CoupleSt. Vincent de PaulHomebound MinistryOffice ReceptionistMoney CounterNurserySchool
Complete the following information for yourself:
First Name*
Middle Name*
Maiden Name (if Applicable)
Last Name (if different)
Date of Birth*

MonthDayYear
Date
Religion*
Occupation*
Language Spoken at home*
Disability (if applicable)
Phone Number*
Please enter a valid phone number.
Sacraments

Complete to the best of your knowledge. If unknown, type "UNKNOWN"
Baptism: Church Name
Baptism: Church City & State
Baptism Date

MonthDayYear
Date
1st Communion: Church Name
1st Communion: Church City & State
1st Communion Date

MonthDayYear
Date
Confirmation: Church Name
Confirmation: Church City & State
Confirmation Date

MonthDayYear
Date
Do you need to add an additional family member?

YesNo
First Name
Middle Name
Last Name (if different)
Maiden Name (if Applicable)
Spouse

HusbandWife
Date of Birth

MonthDayYear
Date
Religion
Occupation
Disability (if applicable)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Sacraments

Complete to the best of your knowledge. If unknown, type "UNKNOWN"
Baptism: Church Name
Baptism: Church City & State
Baptism Date

MonthDayYear
Date
1st Communion: Church Name
1st Communion: Church City & State
1st Communion Date

MonthDayYear
Date
Confirmation: Church Name
Church Name, City & State
Confirmation: Church City & State
Confirmation Date

MonthDayYear
Date
Do you need to add an additional family member?

YesNo
First Name
Middle Name
Last Name (if different)
Child

SonDaughter
Date of Birth

MonthDayYear
Date
Religion
Occupation
Disability (if applicable)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Sacraments

Complete to the best of your knowledge. If unknown, type "UNKNOWN"
Baptism: Church Name
Church Name, City & State
Baptism: Church City & State
Baptism Date

MonthDayYear
Date
1st Communion: Church Name
1st Communion: Church City & State
1st Communion Date

MonthDayYear
Date
Confirmation: Church Name
Confirmation: Church City & State
Confirmation Date

MonthDayYear
Date
Do you need to add an additional family member?

YesNo
First Name
Middle Name
Last Name (if different)
Child

SonDaughter
Date of Birth

MonthDayYear
Date
Religion
Occupation
Disability (if applicable)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Sacraments

Complete to the best of your knowledge. If unknown, type "UNKNOWN"
Baptism: Church Name
Baptism: Church City & State
Baptism Date

MonthDayYear
Date
1st Communion: Church Name
1st Communion: Church City & State
1st Communion Date

MonthDayYear
Date
Confirmation: Church Name
Confirmation: Church City & State
Confirmation Date

MonthDayYear
Date
Do you need to add an additional family member?

YesNo
First Name
Middle Name
Last Name (if different)
Child

SonDaughter
Date of Birth

MonthDayYear
Date
Religion
Occupation
Disability (if applicable)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Sacraments

Complete to the best of your knowledge. If unknown, type "UNKNOWN"
Baptism: Church Name
Baptism: Church City & State
Baptism Date

MonthDayYear
Date
1st Communion: Church Name
1st Communion: Church City & State
1st Communion Date

MonthDayYear
Date
Confirmation: Church Name
Confirmation: City & State
Confirmation Date

MonthDayYear
Date
Do you need to add an additional family member?

YesNo
First Name
Middle Name
Last Name (if different)
Child

SonDaughter
Date of Birth

MonthDayYear
Date
Religion
Occupation
Disability (if applicable)
Phone Number
Please enter a valid phone number.
Email
example@example.com
Sacraments

Complete to the best of your knowledge. If unknown, type "UNKNOWN"
Baptism: Church Name
Baptism: Church City & State
Baptism Date

MonthDayYear
Date
1st Communion: Church Name
1st Communion: Church City & State
1st Communion Date

MonthDayYear
Date
Confirmation: Church Name
Confirmation: Church City & State
Confirmation Date

MonthDayYear
Date
Should be Empty:

St. John Nepomuk Catholic Church Parish Registration Form

Sacraments

Sacraments

Sacraments

Sacraments

Sacraments

Sacraments