CONFIDENTIAL PARISH CENSUS FORM
I am registering to become a member of:
St. Mary Catholic Church
St. Martin de Porres Mission
FAMILY NAME (LAST ONLY)
Primary Phone Number
MAILING ADDRESS
DATE
LANGUAGES SPOKEN @ HOME
ANY SPECIAL NEEDS?
Would you like to receive church giving envelopes?
YES
NO
Online Giver?
YES
List all those living with you.
Include LAST name, if DIFFERENT than
Family name.
Head of Household
Head of Household Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
Occupation or School
Are you in a valid Church marriage?
HIS CELL #_
HIS EMAIL ADDRESS
Spouse (if one)
Spouse Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
Occupation or School
Are you in a valid Church marriage?
HER CELL#
HER EMAIL ADDRESS
1. Dependent Children under 18yrs of age
1. Dependent Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
School
Grade
2. Dependent Children under 18yrs of age
2. Dependent Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
School
Grade
3. Dependent Children under 18yrs of age
3. Dependent Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
School
Grade
4. Child or Other adults above 18yrs of age
4. Dependent Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
Occupation or School
Grade
5. Child or Other adults above 18yrs of age
5. Dependent Gender
Please Select
M
F
Date of Birth
Religion
Choose all that apply
Baptized
First Communion
Confirmed
Convert
Occupation or School
Grade
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