Envelope number
St. Elizabeth Ann Seton Catholic CommunityInformation Card–English
Last Name:
Mailing Name:
(How you want your mail addressed to you. i.e. Mr. & Mrs. John Doe)
Mr.
Mrs.
Mr. & Mrs.
Ms.
Miss
Residence Address:
City, CA Zip Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone:
Format: (000) 000-0000.
Cell Phone:
Format: (000) 000-0000.
Mailing Address (If different from residence):
City, Zip Code
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email Address:
example@example.com
Ethnicity:
Language(s) Spoken at Home:
St. Elizabeth Ann Seton Catholic Community Information Card–EnglishFamily Members
Head of Household: Husband if married or single person
First Name
Middle Initial
Last Name
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City and State of Birth:
Marital Status
Single
Married
Widowed
Divorced
Wedding Date (if married):
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Wife:
First Name
Middle Initial
Last Name
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City and State of Birth:
Child 1:
First Name
Middle Initial
Last Name
Gender:
M
F
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City and State of Birth:
Child 2:
First Name
Middle Initial
Last Name
Gender:
M
F
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
City and State of Birth:
Child 3:
First Name
Middle Initial
Last Name
Gender:
M
F
Date of Birth:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Use additional card if more than three children.
I understand that this is for information only and that I will not be fully registered and receive contribution envelopes until I have attended an Orientation and Registration Meeting which is held monthly.
Signature:
Date:
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
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