Church of the Resurrection-Baptism Registration

Church of the Resurrection-Baptism Registration

O.C.I.A. REGISTRATION
Full Name *

First NameMiddle NameLast NameSuffix
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Format: (000) 000-0000.
E-mail*
example@example.com
Date of Birth*

MonthDayYear
Date
City & State of Birth*

Father's Name*

First NameMiddle NameLast NameSuffix
Religion of Father*
Ex. Catholic, Presbyterian, Methodist, none, etc.
Mother's Full Maiden Name*

First NameMiddle NameLast NameSuffix
Religion of Mother*
Ex. Catholic, Presbyterian, Methodist, none, etc.

Sacramental History
YesNo

YesNo
If you received Baptism in another church (not Catholic), please answer the following:
Date of Baptism

MonthDayYear
Date
Denomination
(ex. Episcopalian, Lutheran, Orthodox, etc.)
Name of Church/Location of Baptism
Address of Church/Location of Baptism

Street Address

Street Address Line 2

CityState

Zip CodeCountry

Catholic Sacrament History
Church you received Catholic Baptism*
Date of Catholic Baptism*

MonthDayYear
Date
Address of Church/Location of Baptism*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
YesNo
Address of Church/Location of First Holy Communion (if different from church of Baptism)

Street Address

Name of Church/Location

CityState / Province

Postal / Zip Code
YesNo
Address of Church/Location of Confirmation (if different from church of Baptism)

Street Address

Name of Church/Location

CityState / Province

Postal / Zip Code

YesNo
Remarks (optional)
Should be Empty: