PARISH REGISTRATION FORM
Family Last Name
*
Family Phone Number
*
Format: (000) 000-0000.
Family Email Address
*
example@example.com
Family Street Address
*
City Zip Code
*
Which option below best represents your family?
*
Married Head of Household & Spouse with Children at Home
Married Head of Household & Spouse with NO Children at Home
Single, Engaged, Divorced or Widowed with Children at Home
Single, Engaged, Divorced, Widowed with NO Children at Home
If single, please choose appropriate status
Single
Engaged
Divorced
Widowed
Head of Household Information
Last Name (if different than Family Last Name)
Maiden Name (if applicable)
First Name
Middle Name
Preferred Name (if different than first name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Does the Head of the Household have an email address that is different than the Family Email Address?
Yes
No
If yes, what is it
example@example.com
Cell Phone Number
Format: (000) 000-0000.
Back
Next
Employment Information
Occupation
Employer
Work Phone
Format: (000) 000-0000.
Veteran or Active Military
No
Yes, I'm a veteran
I am currently active military
Virtus Trained
Yes
No
Religion & Sacramental Information
Religion
Catholic
Protestant
Other
Has Been Baptized
Yes
No
If applicable, date of baptism
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Church of First Communion
City & State of First Communion
Back
Next
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Spouse Information
Last Name (if different than Family Last Name)
Maiden Name (if applicable)
First Name
Middle Name
Preferred Name (if different than first name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
Does the Spouse have an email address that is different than the Family Email Address?
Yes
No
If yes, what is it
Cell Phone Number
Format: (000) 000-0000.
Employment Information
Occupation
Employer
Work Phone
Format: (000) 000-0000.
Veteran or Active Military
No
Yes I am a veteran
I am Active Military
Back
Next
Virtus Trained
Yes
No
Religion & Sacramental Information
Religion
Catholic
Protestant
Other
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Marriage Information
Were you married in the Catholic Church?
Yes
No
If yes, date of marriage in the Catholic Church
Back
Next
Church of Marriage
City & State of Marriage
If no, did you receive dispensation to be married outside of the church?
Yes
No
Date of Marriage outside the church
Helpful to Know
Name of Last Parish
City & State of Last Parish
Information About Children
If applicable, how many children to you have living at home?
1
2
3
4
5
6
Child #1
Last Name
First Name
Middle Name
Preferred name (if different than First Name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
School (If younger than school age, please type N/A)
School Grade (if applicable)
Back
Next
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Child #2
Name
First and Middle Names
Last Name
Preferred name (if different than First Name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
School (If younger than school age, please type N/A)
School Grade (if applicable)
Back
Next
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Child #3
Name
First and Middle Names
Last Name
Preferred name (if different than First Name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
School (If younger than school age, please type N/A)
School Grade (if applicable)
Back
Next
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Child #4
Name
First Name
Middle Name
Last Name
Preferred name (if different than First Name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
School (If younger than school age, please type N/A)
School Grade (if applicable)
Back
Next
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Child #5
Name
First and Middle Names
Last Name
Preferred name (if different than First Name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
School (If younger than school age, please type N/A)
School Grade (if applicable)
Back
Next
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
Child #6
Last Name
First Name
Middle Name
Preferred name (if different than First Name)
Date of Birth
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Gender
Male
Female
School (If younger than school age, please type N/A)
School Grade (if applicable)
Back
Next
Has Been Baptized
Yes
No
If applicable, date of baptism
Church of Baptism
City & State of Baptism
Has Received First Communion
Yes
No
If applicable, date of First Communion
Church of First Communion
City & State of First Communion
Has Been Confirmed
Yes
No
If applicable, date of Confirmation
Church of Confirmation
City & State of Confirmation
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