Language
English (US)
Spanish (Latin America)
Parish Registration
St. Mary's Catholic Church in Bellevue, NE
Head of Household Name
*
First Name
Middle Name
Last Name
Preferred First Name
First Name
Maiden Name
If appropriate
Date of Birth
*
-
Month
-
Day
Year
Date
Place of birth (city and state)
Gender
*
Male
Female
Religion
*
What faith do you practice?
Family/Primary Email
*
example@example.com
Home Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Primary Language
*
English
Spanish
Other
Secondary Language
English
Spanish
Other
Employer/Occupation
Financial Stewardship Options
*
I would like to receive envelopes
I would like information on Electronic Stewardship
Sacraments
Baptized
*
Yes
No
Church & Approx. Year of Baptism
Please add City and State of Church
Holy Communion
*
Yes
No
Church
Please add City and State of Church
Confirmation
*
Yes
No
Church
Please add City and State of Church
Marital Status
*
Single
Married
Divorced
Widowed
Marriage Date
Does the Catholic Church Recognize your marriage?
Yes - we are married in the Church
No
Back
Next
Spouse Name (if applicable)
First Name
Middle Name
Last Name
Preferred First Name
First Name
Maiden Name (Please put your Maiden name here!)
If appropriate
Date of Birth
-
Month
-
Day
Year
Date
Gender
Male
Female
Religion
What faith do you practice?
Email
example@example.com
Cell Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Primary Language
English
Spanish
Other
Secondary Language
English
Spanish
Other
Employer/Occupation
Sacraments
Baptized
Yes
No
Church & Approx. Year of Baptism
Please add City and State of Church
Holy Communion
Yes
No
Church
Please add City and State of Church
Confirmation
Yes
No
Church
Please add City and State of Church
Back
Next
Children
Child 1
Do you have children that are joining the parish with you?
*
Yes
No
Submit
Child 1 Name
First Name
Middle Name
Last Name
Preferred First Name
First Name
Role - Son, Daughter, Other (step-child)
Son
Daughter
Other
Date of Birth
-
Month
-
Day
Year
Date
City and State of Birth
Religion
What faith do they practice?
Primary Language
English
Spanish
Other
Secondary Language
English
Spanish
Other
School Attending
School
School Grade
Sacraments
Baptized
Yes
No
Church & Approx. Year of Baptism
Please add City and State of Church
Holy Communion
Yes
No
Church
Please add City and State of Church
Confirmation
Yes
No
Church
Please add City and State of Church
Back
Next
Do you have another child to enter?
Yes
No
Submit
Child 2
Child 2 Name
First Name
Middle Name
Last Name
Preferred First Name
First Name
Role - Son, Daughter, Other (step-child)
Son
Daughter
Other
Date of Birth
-
Month
-
Day
Year
Date
City and State of Birth
Religion
What faith do they practice?
Primary Language
English
Spanish
Other
Secondary Language
English
Spanish
Other
School Attending
School
School Grade
Sacraments
Baptized
Yes
No
Church & Approx. Year of Baptism
Please add City and State of Church
Holy Communion
Yes
No
Church
Please add City and State of Church
Confirmation
Yes
No
Church
Please add City and State of Church
Back
Next
Do you have more children to enter?
*
Yes
No
Submit
Children - Fill out Child 3's information below. If you have more children to enter, Select "Add Child" and enter their information. When you have entered the final child's information, click Submit.
*
Submit
Should be Empty: