St. Agnes OCIA - Adult Registration Form
Information on this form is held in confidence and is not shared without your permission
Today's Date:
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Month
-
Day
Year
Date
Name:
First Name
Middle Initial
Last Name
Maiden Name (if applicable):
Date of Birth:
-
Month
-
Day
Year
Date
Age:
Place of Birth: (include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)
Name of Father:
Name of Mother:
I. CONTACT INFORMATION
Full Mailing Address:
Phone: (Day Time)
Format: (000) 000-0000.
(Evening/Weekend)
Format: (000) 000-0000.
Cell/Mobile Phone:
Format: (000) 000-0000.
Occupation:
Email: (Home)
example@example.com
(Other)
example@example.com
II. RELIGIOUS HISTORY
1. What, if any, is your present religious affiliation?
2. Have you ever been baptized?
Yes
No
I am not sure
rIf answered "Yes" to Question 2, please provide the following information:. In what denomination were you baptized?
(b) Date or your approximate age when you were baptized:
(c) Baptismal Name (if different from current name):
(d) Place of Baptism (name of church/denomination):
(e) Address, if known:
(f) Location, if known: (include locality (town, city, county, etc.), region (state, province, territory, etc.), and country)
3. If you were baptized as a Catholic, circle those sacraments you have already received:
Reconciliation (Confession)
Eucharist (First Communion)
Confirmation
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III. CURRENT MARITAL STATUS
Current Marital Status
I have never been married.
I am engaged to be married.
I am married.
I am married but separated from my spouse.
I am divorced and have not remarried.
I am a widow/widower and have not remarried.
Additional Marital Information:
IV. FAMILY INFORMATION
List the name(s) of any children or other dependents (e.g., Daughter – Jane; Stepson – John).
Relationship
Name
Age:
Relationship
Name
Age:
Relationship
Name
Age:
Relationship
Name
Age:
Relationship
Name
Age:
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V. GENERAL QUESTIONS
1. What or who has led you to want to know more about the Catholic Faith?
2. Please describe the types of religious education you have received, as a child and as an adult.
3. What contact have you had with the Catholic Church to date?
4. What are some of the questions or concerns you have about the Catholic Church?
5. At this point in time, which of the following statements best describes your present feelings and thoughts about the possibility of joining the Catholic Church? (please circle one)
A. I need much more information about the Catholic Church before I would consider joining.
B. I am considering joining, but I am still unsure about it.
C. I am fairly sure that I would like to join, but I still need some time to study and pray about it.
D. I am fairly sure that I want to join the Catholic Church.
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