NEW FAMILY REGISTRATION FORM
Please complete this form for Family Information. If there are members in your household 21 years of age or older, we encourage them to register separately. If there are members of the family with special needs that the parish can address, please notify the office.
Which Parish would you like to join?
St. Ann, Gulf Breeze
Our Lady of the Assumption, Pensacola Beach
Would you like the Parish to send you Contribution Envelopes?
Yes
No
Family Last Name:
Home Address:
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Mailing Address (If Different):
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Primary Phone:
Format: (000) 000-0000.
Secondary Phone:
Format: (000) 000-0000.
PRIMARY LANGUAGE AT HOME:
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Head of Household
Head of Household
Marital Status
Please Select
Single
Married
Divorced
Separated
Widowed
Last Name
First Name
Middle Name
Title
Preferred Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Type
Home
Cell
Occupation
Religion
Baptism Date
-
Month
-
Day
Year
Date
Baptism Church Name
Baptism City/State
1st Reconciliation Date
-
Month
-
Day
Year
Date
1st Reconciliation Church Name
1st Reconciliation City/State
1st Communion Date
-
Month
-
Day
Year
Date
1st Communion Church Name
1st Communion City/State
Confirmation Date
-
Month
-
Day
Year
Date
Confirmation Church Name
Confirmation City/State
RCIA/OCIA Process Date
-
Month
-
Day
Year
Date
RCIA/OCIA Church Name
RCIA/OCIA City/State
Only complete the following Drop Down Menus that are Applicable
When finished entering all information, click NEXT at the bottom and preview the information before clicking SUBMIT.
Spouse Information
Marital Status
Please Select
Single
Married
Divorced
Separated
Widowed
Last Name
First Name
Middle Name
Title
Preferred Name
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Phone Type
Home
Cell
Occupation
Religion
Baptism Date
-
Month
-
Day
Year
Date
Baptism Church Name
Baptism City/State
1st Reconciliation Date
-
Month
-
Day
Year
Date
1st Reconciliation Church Name
1st Reconciliation City/State
1st Communion Date
-
Month
-
Day
Year
Date
1st Communion Church Name
1st Communion City/State
Confirmation Date
-
Month
-
Day
Year
Date
Confirmation Church Name
Confirmation City/State
RCIA/OCIA Initiation Date
-
Month
-
Day
Year
Date
RCIA/OCIA Church Name
RCIA/OCIA City/State
Marriage Information
Matrimony Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Wife's Maiden Name:
Married by Priest/Deacon:
Yes
No
Child 1
Child 1
(Skip Section if doesn't apply)
Name
First Name
Middle Initial
Last Name
Preferred Name:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
M
F
Religion:
School:
Grade Level:
Baptism Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Reconciliation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Communion Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Confirmation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Child 2
Child 2
(Skip section is doesn't apply)
Name
First Name
Middle Initial
Last Name
Preferred Name:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
M
F
Religion:
School:
Grade Level:
Baptism Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Reconciliation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Communion Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Confirmation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Child 3
Child 3
(Skip section if doesn't apply)
Name
First Name
Middle Initial
Last Name
Preferred Name:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
M
F
Religion:
School:
Grade Level:
Baptism Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Reconciliation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Communion Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Confirmation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Child 4/Other Adult living @ Home
Name
First Name
Middle Initial
Last Name
Preferred Name:
Date of Birth:
-
Month
-
Day
Year
Date
Gender:
M
F
Religion:
School:
Grade Level:
Baptism Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Reconciliation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
1st Communion Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
Confirmation Date:
-
Month
-
Day
Year
Date
Church Name:
City/State:
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Thank you for registering with us!
Please click submit if all information has been successfully entered.
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