Parish Census

CONFIDENTIAL PARISH CENSUS FORM
I am registering to become a member of:

St. Mary Catholic ChurchSt. 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?

YESNO
Online Giver?

YES
List all those living with you.

Include LAST name, if DIFFERENT than Family name.
Head of Household
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
Occupation or School
Are you in a valid Church marriage?
HIS CELL #_
HIS EMAIL ADDRESS
Spouse (if one)
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
Occupation or School
Are you in a valid Church marriage?
HER CELL#
HER EMAIL ADDRESS
1. Dependent Children under 18yrs of age
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
School
Grade
2. Dependent Children under 18yrs of age
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
School
Grade
3. Dependent Children under 18yrs of age
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
School
Grade
4. Child or Other adults above 18yrs of age
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
Occupation or School
Grade
5. Child or Other adults above 18yrs of age
Date of Birth
Religion
Choose all that apply

BaptizedFirst CommunionConfirmedConvert
Occupation or School
Grade
Should be Empty: