St. Pius X Parishioner Registration Form

St. Pius X Parishioner Registration Form
Name*

PrefixFirst NameLast Name
Date of Birth

MonthDayYear
Name

PrefixFirst NameLast Name
Date of Birth

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Family Email
Primary Phone*

Area CodePhone Number
Secondary Phone

Area CodePhone Number
Is primary phone a cell phone?*

YesNo
Please list dependant children living in your household. We kindly ask that adults, 26 and older, complete their own registration form.
Child 1

First NameLast Name
Date of Birth

MonthDayYear
School
Child 2

First NameLast Name
Date of Birth

MonthDayYear
School
Child 3

First NameLast Name
Date of Birth

MonthDayYear
School
Child 4

First NameLast Name
Date of Birth

MonthDayYear
School
Now that you have joined our parish family, how can we help you? Please let us know if you would like us to contact you about any of the following:
Children and Teens
Sacraments
Ministry or volunteer opportunities
Should be Empty: