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Parish Registration Form
Welcome to The Catholic Community of Pleasanton! We're glad you're here! Please tell us a little bit more about yourself!
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1
Family Name
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Address
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Street Address
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Samoa
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Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
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South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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3
Phone Number
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Please enter a valid phone number.
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4
Primary Email
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example@example.com
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5
Secondary Email
example@example.com
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6
Sunday Collection Envelopes
*
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Would You Like Sunday Collection Envelopes Mailed To You?
YES
NO
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7
How Long Have You Lived In The Area?
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8
Do You Have Someone With A Disability In Your Household?
YES
NO
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9
Primary Adult #1
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First Name
Last Name
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10
Primary Adult #1 - Gender
*
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Please Select
Male
Female
Please Select
Please Select
Male
Female
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11
Primary Adult #1 - Marital Status
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Please Select
Married
Single
Divorced
Widowed
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Please Select
Married
Single
Divorced
Widowed
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12
Primary Adult #1 - Date Of Birth
*
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-
Date
Month
Day
Year
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13
Primary Adult #1 - Ethnicity
*
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Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
Please Select
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
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14
Primary Adult #1 - Religion
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15
Primary Adult #1 - Are You Baptized?
*
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Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
Please Select
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
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16
Primary Adult #1 - First Reconciliation (Confession)?
*
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YES
NO
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17
Primary Adult #1 - First Eucharist (Communion)?
*
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YES
NO
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18
Primary Adult #1 - Confirmation?
*
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YES
NO
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19
Primary Adult #2
First Name
Last Name
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20
Primary Adult #2 - Gender
Please Select
Male
Female
Please Select
Please Select
Male
Female
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21
Primary Adult #2 - Marital Status
Please Select
Married
Single
Divorced
Widowed
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Please Select
Married
Single
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Widowed
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22
Primary Adult #2 - Date Of Birth
-
Date
Month
Day
Year
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23
Primary Adult #2 - Ethnicity
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
Please Select
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
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24
Primary Adult #2 - Religion
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25
Primary Adult #2 - Are You Baptized?
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
Please Select
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
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26
Primary Adult #2 - First Reconciliation (Confession)?
YES
NO
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27
Primary Adult #2 - First Eucharist (Communion)?
YES
NO
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28
Primary Adult #2 - Confirmation?
YES
NO
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29
How Many Children Will You Be Registering?
*
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30
Child #1 - Name
First Name
Last Name
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31
Child #1 - Gender
Please Select
Male
Female
Please Select
Please Select
Male
Female
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32
Child #1 - Date of Birth
-
Date
Month
Day
Year
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33
Child #1 - Ethnicity
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
Please Select
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
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34
Child #1 - Relationship To Primary Adult
Please Select
Child
Grandchild
Step Child
Please Select
Please Select
Child
Grandchild
Step Child
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35
Child #1 - Religion
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36
Child #1 - Baptized?
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
Please Select
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
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37
Child #1 - First Reconciliation (Confession)?
YES
NO
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Enter
38
Child #1 - First Eucharist (Communion)?
YES
NO
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39
Child #1 - Confirmation?
YES
NO
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40
Child #2 - Name
First Name
Last Name
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41
Child #2 - Gender
Please Select
Male
Female
Please Select
Please Select
Male
Female
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42
Child #2 - Date of Birth
-
Date
Month
Day
Year
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43
Child #2 - Ethnicity
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
Please Select
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
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44
Child #2 - Relationship To Primary Adult
Please Select
Child
Grandchild
Step Child
Please Select
Please Select
Child
Grandchild
Step Child
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45
Child #2 - Religion
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46
Child #2 - Baptized?
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
Please Select
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
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47
Child #2 - First Reconciliation (Confession)?
YES
NO
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48
Child #2 - First Eucharist (Communion)?
YES
NO
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49
Child #2 - Confirmation?
YES
NO
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50
Child #3 - Name
First Name
Last Name
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51
Child #3 - Gender
Please Select
Male
Female
Please Select
Please Select
Male
Female
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52
Child #3 - Date of Birth
-
Date
Month
Day
Year
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53
Child #3 - Ethnicity
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
Please Select
Please Select
Caucasian
African American
Hispanic
Chinese
Korean
Filipino
Asian Indian
Vietnamese
Asian
Japanese
Other
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54
Child #3 - Relationship To Primary Adult
Please Select
Child
Grandchild
Step Child
Please Select
Please Select
Child
Grandchild
Step Child
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55
Child #3 - Religion
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56
Child #3 - Baptized?
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
Please Select
Please Select
Roman Catholic
Greek Orthodox
Lutheran
Methodist
Baptist
Episcopal
Other
Not Baptized
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57
Child #3 - First Reconciliation (Confession)?
YES
NO
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58
Child #3 - First Eucharist (Communion)?
YES
NO
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59
Child #3 - Confirmation?
YES
NO
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