RCIA- Adapted Inquiry Intake Form
Father's Name
*
First
Middle Name
Last Name
Father's Cell Number (skip if not applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Father's Email (skip if not applicable)
example@example.com
Mother's Name
*
First
Middle Name
Last Name
Mother's Cell Number (skip if not applicable)
Please enter a valid phone number.
Format: (000) 000-0000.
Mother's Email (skip if not applicable)
example@example.com
Family Address
*
Street Address
Apartment/Building #
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Why are you seeking the Sacraments at this time for your child?
*
What Catechesis has the child(ren) received to date? Where?
*
Is your family attending Sunday Mass weekly?
*
Please Select
Yes
No
Yes, but not consistently.
If your family is attending Sunday Mass, weekly, which parish are you attending? (Parish Name & City)
*
Parish Name
City
Are you registered at a Catholic Parish?
*
Yes
No
If so, where? (Parish Name & City)
*
Parish Name
City
Have you been to Holy Family Church?
*
Please Select
Yes
No
Child's Name
*
First Name
Last Name
Child's Gender
*
Please Select
Female
Male
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Current Age
*
Child's Grade
*
Please Select
3
4
5
6
7
8
9
10
11
12
Baptized Catholic?
*
Please Select
Yes
Not Baptized
Baptized, but not Catholic
Date of Baptism
-
Month
-
Day
Year
Date
If Baptized, Non-Catholic, please state the denomination.
*
Do you have additional children to add?
*
Please Select
Yes
No
Save
Submit
Child's Name
*
First Name
Last Name
Child's Gender
*
Please Select
Female
Male
Child's Date of Birth
*
-
Month
-
Day
Year
Date
Child's Current Age
*
Child's Grade
*
Please Select
3
4
5
6
7
8
9
10
11
12
Baptized Catholic?
*
Please Select
Yes
Not Baptized
Baptized, but not Catholic
If Baptized, Catholic: Church of Baptism, City, State. (If not- skip)
Church
City, STATE
If Baptized, Non-Catholic, please state the denomination.
*
Do you have additional children to add?
*
Please Select
Yes
No
Save
Submit
Should be Empty: