5-1-24 HNOJ Parish Registration-Espanol v.3

The Holy Name of Jesus Catholic Community, Inc.

115 W Olive Ave., Redlands, CA 92373

Parish Registration
Welcome to The Holy Name of Jesus! We would like to know why you are registering with our parish. Below, please indicate the reason(s) you are completing this form (check all that apply):

To register as a part of The Holy Name of Jesus familyTo enroll my child(ren) in sacramental classesTo enroll myself in adult sacramental classesFor Marriage preparationOther
Family Information
Home Address*

Street Address

If Apartment, please provide number

CityState / Province

Postal / Zip Code
Mailing Address (if different from above)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Best phone number to be reached*
Is this a Cell or Home*

1st Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests
Would you like to add another family member?

YESNO

2nd Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

(yes or no will suffice)
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests
Would you like to add another family member?

YESNO

3rd Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests
Would you like to add another family member?

YESNO

4th Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests
Would you like to add another family member?

YESNO

5th Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests
Would you like to add another family member?

YESNO

6th Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests
Would you like to add another family member?

YESNO

7th Family Member Information

(please use legal name) For children 25 and over, please register separately
Name

PrefixFirst NameMiddle NameLast NameSuffix
Gender: Male/Female*
Role: (head of household, husband/wife, child) if other, explain*
Nickname (if Any)
* What is Your Maiden Last Name (for wife only)
Date of Birth*

MonthDayYear
Date
City and State of Birth*
Marital Status*
Religion*
Language*
Occupation (career type or student)*
Retired (Y/N)? *
School Name (if student)
Ethnicity*
Special Needs (allergies, disabilities, etc.)
Cell Number*
Please enter a valid phone number.
Work Number
Please enter a valid phone number.
Email
example@example.com
Sacrament Information

Please tell us whether or not you have received the following sacraments (yes or no will suffice)
BAPTISM
1st RECONCILIATION (CONFESSION)
1st EUCHARIST (COMMUNION)
CONFIRMATION
MARRIAGE
If Married, Please Enter Marriage Date

MonthDayYear
Date
If Married, Please Enter What Type of Marriage Ceremony:
Catholic Church, Civil or Other Faith
Additional Comments/Requests

Thank you for completing your Registration. If there are any questions, a parish staff member will be contacting you.
Should be Empty:

Family Information

1st Family Member Information

Sacrament Information

2nd Family Member Information

Sacrament Information

Sacrament Information

3rd Family Member Information

Sacrament Information

4th Family Member Information

Sacrament Information

5th Family Member Information

Sacrament Information

6th Family Member Information

Sacrament Information

7th Family Member Information

Sacrament Information

Thank you for completing your Registration. If there are any questions, a parish staff member will be contacting you.