Parish Registration

Thanks for taking a moment to register your household's information with our parish's office. Please fill out the form as completely as possible and then click submit.

Name

First Name

Middle Name

Last Name

Spouse Name (if married)

First Name

Middle Name

Last Name

First and Last Name(s) of Other Adult(s) in Household and Date of Birth

Primary Phone

Required* --

Secondary Phone

Email Address

Required*

Alternative Email Address

Home Address

Street 1

Street 2

City

State

Zip

Other Preferred Means of Communication? Please list here.

Date of Birth

Spouse Date of Birth

Check one

Please select one

	Married
	Single
	Separated
	Divorced
	Widowed

List (Single Choice)

	Spouse (Catholic)
	Spouse (Non-Catholic)

CHILD OR CHILDREN

Name of Child

First Name

Last Name

Date of Birth

Date of Birth //

Date of Baptism

Name of 2nd Child

First Name

Last Name

Date of Birth

Date of Baptism

Name of 3rd Child

First Name

Last Name

Date of Birth

Date of Baptism

Name of 4th Child

First Name

Last Name

Date of Birth

Date of Baptism

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