St. Marguerite d'Youville Parish - Rite of Christian Initiation of Adults (RCIA) Initial Information Form

St. Marguerite d'Youville Parish - Rite of Christian Initiation of Adults (RCIA)

Initial Information Form (Adult)
Name of Enquirer*

First NameMiddle Name(s)Last NameMaiden Name (if applicable)
Gender*

MaleFemale

PERSONAL INFORMATION
Address*

Street Address

Street Address Line 2

CityProvince

Postal / Zip Code
Phone (Home)*
Please enter a valid phone number.
Phone (Work)
Please enter a valid phone number.
Phone (Cell)
Please enter a valid phone number.
Email*
example@example.com
Date of Birth *

MonthDayYear
Date
Place of Birth *

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

PARENTS INFORMATION
Father's Name*

First NameMiddle Name(s)Last Name
Mother's Name*

First NameMiddle Name(s)Last NameMaiden Name
Father's Religion*
Mother's Religion*

BAPTISM INFORMATION
Have you ever been baptized?*

Yes (provide certificate, record, or affidavit)No
Certificate of Baptism, Record of Affifavit*

Cancelof
Date of Baptism*

MonthDayYear
Date
Catholic Rite of Christian Denomination*
(e.g. Roman Catholic, Presbyterian, United Church, etc.)
Place of Baptism:*

Name of Church

Street Address

CityProvince

Zip CodeCountry

CHILDREN
Do you have children you would like to prepare for Christian initiation?*

Yes (If yes, provide name and age of each child below)No
First Child: Name and Age

First NameLast NameAge
Second Child: Name and Age

First NameLast NameAge
Third Child: Name and Age

First NameLast NameAge
Fourth Child: Name and Age

First NameLast NameAge

DECLARATION
I, the undersigned, declare that the information provided on this form and all other forms in the appendix are true and accurate.
Name*
Please type in full name
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty: