Parish Census Form

DEADLINE: SEPTEMBER 1, 2023

St. Francis of Assisi Parish

203 E. Main St., PO Box 730

Teutopolis, IL 62467

Phone: (217)961-6404 Fax: (217)961-0680

Parish email: sfe@stfrancischurch.com

IMPORTANT: The information you provide will be held in strict confidentiality and will be used solely for the pastoral needs of the parish and not shared with any third party.

Family Name

Address

Street Address

Mailing Address

CityState / Province

Postal / Zip Code

Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

We (I) are registered parishioners and deisre to continue as such.We (I) are registered parishioners and desire to continue, even though we do not attend Mass on a regular basis.We (I) are registered parishioners but do not attend Mass. We do wish to remain on the parish files.We (I) are currently registered parishioners, but wish to be removed from the parish files.We (I) are not registered parishioners, but would like to register.

If not active, what barriers exist that keep you from participating?

Head of Household:
First Name:   HH First Name
Middle Name:   HH Middle Name
Last Name:   HH Last Name
Maiden Name:  HH Maiden Name
Cell Phone Number:     HH Cell Phone Number
Email Address:   HH Email Address
Date of Birth:     HH Date of Birth
Religion:   HH Religion
Marital Status:
Date of Marriage:   Date of Marriage
Is your marriage valid according to the Catholic Church?
If divorced, was marriage annulled?
Occupation: Occupation

Spouse:
First Name:   SP First Name
Middle Name:   SP Middle Name
Last Name:   SP Last Name
Maiden Name:   SP Maiden Name
Cell Phone Number:   SP Cell Number
Email Address:   SP Email Address
Date of Birth:   SP Date of Birth
Religion:   SP Religion
Marital Status:
Date of Marriage:   SP Date of Marriage
Is your marriage valid according to the Catholic Church:
If divorced, was marriage annulled?
Occupation   Sp Occupation

Please answer the questions below.

If you have other people living in your home, you are asked to provide their information after these questions. Please include your children attending college and living away from home but still have a permanent residence at your home.)

Would you (or any other family member) in a nursing home or assisted living like to be visited by Father?       Yes    N No
If so, please list name and address of the person. blanks
If someone is confined to home, would they like to receive Holy Communion regularly:    Yes    No
If so, please list name and address of the person.   Type a label

Are there any programs/ministries you would like to have implemented in our parish or you would like to participate in?

Do you wish to contribute your weekly offering through: online giving, envelopes or both? blanks
Do you already receive offertory envelopes?          Yes    No
Would you like to continue to receive parish offertory envelopes?     Yes   No
How would you like to receive parish news and updates (you may choose more than one):    texts:    emails    Facebook;    bulletin    website
Other method not listed: blank

If you have other people living in your home, you are asked to provide their information after these questions. (Please include your children attending college and living away from home but still have a permanent residence at your home.)

If you do not have any other household members, scroll to the bottom and submit the form.

Other Household Members
Person 1:
First Name:     1 First Name
Middle Name:     1 Middle Name
Last Name:      1 Last Name
Relationship (i.e. son, daughter, friend):     1 Relationship
Gender:
Place of Birth:     1 Place of Birth
Date of Birth:   1 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   1 Baptism location
First Communion:
Confirmation:
Occupation or Grade:   1 Occupation or Grade
Marital Status:
Date of Marriage:   1 Date of Marriage
Is your marriage valid according to the Catholic Church?
If divorced, was marriage annulled?

Person 2:
First Name:      2 First Name
Middle Name:   2 Middle Name
Last Name:    2 Last Name
Relationship (i.e. son, daughter, friend):      2 Relationship
Gender:
Place of Birth:    2 Place of Birth
Date of Birth:    2 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   2 Baptism Location
First Communion:
Confirmation:
Occupation or Grade:   2 Occupation or Grade
Marital Status:
Date of Marriage:    2 Date of Marriage
Is your marriage valid according to the Catholic Church:
If divorced, was marriage annulled?

Person 3:
First Name:   3 First Name
Middle Name:   3 Middle Name
Last Name:   3 Last Name
Relationship (i.e. son, daughter, friend):   3 Relationship
Gender:
Place of Birth:   3 Place of Birth
Date of Birth:   3 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   3 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:   3 Occupation or Grade

Person 4:
First Name:   4 First Name
Middle Name:   4 Middle Name
Last Name:   4 Last Name
Relationship (i.e. son, daughter, friend):   4 Relationship
Gender:
Place of Birth:   4 Place of Birth
Date of Birth:   4 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   4 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:    4 Occupation or Grade

Person 5:
First Name:   5 First Name
Middle Name:   5 Middle Name
Last Name:   5 Last Name
Relationship (i.e. son, daughter, friend):   5 Relationship
Gender:
Place of Birth:   5 Place of Birth
Date of Birth:   5 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   5 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:   5 Occupation or Grade

Person 6:
First Name:   6 First Name
Middle Name:   6 Middle Name
Last Name:   6 Last Name
Relationship (i.e. son, daughter, friend):   6 Relationship
Gender:
Place of Birth:   6 Place of Birth
Date of Birth:   6 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   6 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:   6 Occupation or Grade

Person 7:
First Name:   7 First Name
Middle Name:   7 Middle Name
Last name:   7 Last Name
Relationship (i.e. son, daughter, friend):   7 Relationship
Gender:
Place of Birth:   7 Place of Birth
Date of Birth:   7 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   7 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:   7 Occupation or Grade

Person 8
First Name:   8 First Name
Middle Name:   8 Middle Name
Last Name:   8 Last Name
Relationship (i.e. son, daughter, friend):   8 Relationship
Gender:
Place of Birth:   8 Place of Birth
Date of Birth:   8 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   8 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:   8 Occupation or Grade

Person 9
First Name:   9 First Name
Middle Name:   9 Middle Name
Last Name:   9 Last Name
Relationship (i.e. son, daughter, friend):   9 Relationship
Gender:
Place of Birth:   9 Place of Birth
Date of Birth:   9 Date of Birth
Baptized Catholic:
Church, City & State of Baptism:   9 Location of Baptism
First Communion:
Confirmation:
Occupation or Grade:     9 Occupation or Grade

Other comments and concerns:

Thank you for taking the time to fill out the census form. As changes occur in your family that affect the information you have provided on this form, please let us know, so that we may keep your records complete and up-to-date.