ST. RENE GOUPIL PARISH REGISTRATION

St. Rene Goupil Parish Family Registration

35955 Ryan Rd. Sterling Heights, MI 48310
FAMILY LAST NAME*
PHONE NUMBER*
EMERGENCY PHONE NUMBER*
ADDRESS*
CITY*
STATE*
ZIP CODE*
EMAIL*
example@example.com
ENVELOPE #
Individual Member Information (PERSON 1)*

ROLE:MR.MRS.MS.MISSROLE:MR.MRS.MS.MISS
INDIVIDUAL (PERSON 1) FIRST NAME*
GENDER*

MaleFemale
DATE OF BIRTH*

MonthDayYear
Date
LANGUAGE
PHONE NUMBER*
CELL PHONE NUMBER
EMAIL*
example@example.com
CATHOLIC

YESNO
SACRAMENTS RECEIVED

BAPTISMFIRST EUCHARISTCONFIRMATION
Individual Member (PERON 2)Information

ROLE:MR.MRS.MS.MISSROLE:MR.MRS.MS.MISS
INDIVIDUAL(PERSON 2) FIRST NAME
DATE OF BIRTH

MonthDayYear
Date
GENDER

MaleFemale
LANGUAGE
PHONE NUMBER
CELL PHONE NUMBER
EMAIL
example@example.com
CATHOLIC

YESNO
SACRAMENTS RECEIVED

BAPTISMFIRST EUCHARISTCONFIRMATION
Dependant Children Information
(DEPENDANT 1) FIRST NAME
GENDER

MaleFemale
DATE OF BIRTH

MonthDayYear
Date
SACRAMENTS RECEIVED

BAPTISMFIRST EUCHARISTCONFIRMATION
(DEPENDANT 2)FIRST NAME
GENDER

MaleFemale
DATE OF BIRTH

MonthDayYear
Date
SACRAMENTS RECEIVED

BAPTISMFIRST EUCHARISTCONFIRMATION
(DEPENDANT 3)FIRST NAME
GENDER

MaleFemale
DATE OF BIRTH

MonthDayYear
Date
SACRAMENTS RECEIVED

BAPTISMFIRST EUCHARISTCONFIRMATION
Should be Empty: