St. Elizabeth Ann Seton Parish Registration
If you have problems completing this form contact us at 859-273-1318
Are you?
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New to the Church--Registering in the Parish
Already registered--updating my information
Moving or Leaving the Parish
Other Please Fill The Reason Below
Would you like someone to contact you?
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Yes
No
Contact Immediately by someone at the parish
Family Name
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Name you wish to appear on mailings, etc.
Mailing Address
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Street, City, State, Zip Code
Primary Contact Name
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First, Middle, Last
Primary Contact's Email Address
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example@example.com
Primary Contact's Phone Number
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Please enter a valid phone number.
Preferred Method of Contact
Phone/Text
Email
Primary Contact's Sex/Gender
Male
Female
Primary Contact's Date of Birth
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Month
-
Day
Year
Date
Primary Contact's Occupation/Place of Work
Example: Salesman/Acme Co.
Primary Contact's Sacraments Completed (Select all that apply)
Baptism
First Communion
Confirmation
Baptism Date (if known)
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Month
-
Day
Year
Date
First Communion Date (if known)
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Month
-
Day
Year
Date
Confirmation Date (if known)
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Month
-
Day
Year
Date
List Primary's past or current ministries
Marital Status
Please Select
Single
Married
Divorced
Engaged
Widowed
Wife's Maiden Name (Sometimes needed for parish records)
Location of Marriage Ceremony--Parish (if applicable)--City, State
Examples: St. Mary's--Springfield, KY or St. John's Lutheran--Dearborn, IN or Outdoors--Miami Beach, FL
If either party was/is Catholic, is the marriage sacramental? (Did it occur in a parish or another location with proper permission of the local bishop?)
Please Select
Yes
No
Unknown
If marriage occured at a Catholic Church--yes If marriage occured w/dispensation from bishop--yes If marriage was civil only--no, if unsure--select unknown
Fiancé's name--First Middle Last
Anticipated date of marriage celebration (if known)
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Month
-
Day
Year
Date
Date Married
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Month
-
Day
Year
Date
Spouse's Name--First Middle Last
Spouse's Sacraments Completed (Select all that apply)
Baptism
First Communion
Confirmation
Spouse's Baptism Date (if known)
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Month
-
Day
Year
Date
Spouse's First Communion Date (if known)
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Month
-
Day
Year
Date
Spouse's Confirmation Date (if known)
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Month
-
Day
Year
Date
Spouse's Phone Number
Please enter a valid phone number.
Spouse's Email
example@example.com
Spouse's Occupation/Place of Work
Example: Salesman/Acme Co.
List Spouse's past or current ministries
Do you have children residing in your home?
Please Select
Yes
No
Oldest Child's Name (First Middle Last)
Oldest Child's Sex/Gender
Please Select
Male
Female
Oldest Child's Date of Birth
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Month
-
Day
Year
Date
Oldest Child's Sacraments Completed (Select all that apply)
Baptism
First Communion
Confirmation
Oldest Child's School Attended/Grade
Example: Squires Elementary/3rd
Do you have additional children to register?
Please Select
Yes
No
2nd Child's Name (First Middle Last)
2nd Child's Sex/Gender
Please Select
Male
Female
2nd Child's Date of Birth
-
Month
-
Day
Year
Date
2nd Child's Sacraments Completed (Select all that apply)
Baptism
First Communion
Confirmation
2nd Child's School Attended/Grade
Example: Squires Elementary/3rd
Do you have additional children to register?
Please Select
Yes
No
3rd Child's Name (First Middle Last)
3rd Child's Sex/Gender
Please Select
Male
Female
3rd Child's Date of Birth
-
Month
-
Day
Year
Date
3rd Child's Sacraments Completed (Select all that apply)
Baptism
First Communion
Confirmation
3rd Child's School Attended/Grade
Example: Squires Elementary/3rd
Do you have additional children to register?
Please Select
Yes
No
4th Child's Name (First Middle Last)
4th Child's Sex/Gender
Please Select
Male
Female
4th Child's Date of Birth
-
Month
-
Day
Year
Date
4th Child's Sacraments Completed (Select all that apply)
Baptism
First Communion
Confirmation
4th Child's School Attended/Grade
Example: Squires Elementary/3rd
Do you have additional children to register?
Please Select
Yes
No
If there are more than four (4) children residing with you use this section to include their information. (Include Name, Sex/Gender, Date of Birth, Sacraments Completed and School/Grade).
Special Notes: Use this space to indicate any special circumstances, ministry interest, etc. Also, include and special needs (disability, allergy, etc.)
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