Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Please complete this form to register your family. Copies of sacrament certificates can be sent to the rectory by mail or email; click HERE for contact information. Family Last Name *Family Group Contact Information Name for Mailingex. Mr. & Mrs. John DoeAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip Code Phone *Family Email *Supply one e-mail address that may be used to contact the family as a groupComments Individual Member Information MEMBER #1 (Adult) Mr. / Mrs. / Ms. / Miss / Dr.Member #1 NameFirstMiddleLastSuffix (if applies)if appliesMaiden Name (if applies)GenderMaleFemaleDate of BirthFamily RoleSole Head of the HouseholdHusbandWifeMarital StatusSingleMarriedWidowedSeparatedDivorcedAnnulledEducationHigh School13 Yrs +AssociateBachelor’sMaster’sDoctorateOccupationCell PhoneWork PhonePersonal EmailReligionSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and ChurchConfirmation date and ChurchMarriageCatholic MarriageOther FaithCivil marriageIf marriage was in other faith, please indicate:Marriage dateMarriage Church and church location: MEMBER #2 (Adult) Mr. / Mrs. / Ms. / Miss / Dr.Member #2 NameFirstMiddleLastSuffix (if applies)if appliesMaiden Name (if applies) GenderMaleFemaleDate of BirthFamily RoleSole Head of the HouseholdHusbandWifeMarital StatusSingleMarriedWidowedSeparatedDivorcedAnnulledEducationHigh School13 Yrs +AssociateBachelor’sMaster’sDoctorateOccupationCell PhoneWork PhonePersonal EmailReligionSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and ChurchConfirmation date and Church MEMBER #3 (Child 1) Member #3 NameFirstMiddleLastSuffix (if applies)if appliesGenderMaleFemaleDate of BirthPlace of BirthSchool attending and current gradeReligionReligious EducationAt schoolParish Religious Ed.OtherSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and ChurchConfirmation date and Church MEMBER #4 (Child 2) Member #4 NameFirstMiddleLastSuffix (if applies)if appliesGenderMaleFemaleDate of BirthPlace of BirthSchool attending and current gradeReligionReligious EducationAt schoolParish Religious Ed.OtherSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and ChurchConfirmation date and Church MEMBER #5 (Child 3) Member #5 Name FirstMiddleLastSuffix (if applies)if appliesGenderMaleFemaleDate of BirthPlace of Birth School attending and current grade Religion Religious Education At schoolParish Religious Ed.OtherSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and Church Confirmation date and Church MEMBER #6 (Child 4) Member #6 Name FirstMiddleLastSuffix (if applies) if appliesGenderMaleFemaleDate of BirthPlace of BirthSchool attending and current grade ReligionReligious EducationAt schoolParish Religious Ed.OtherSacrament Baptism date and ChurchReconciliation date and Church First Eucharist date and ChurchConfirmation date and Church MEMBER #7 (Child 5) Member #7 Name FirstMiddleLastSuffix (if applies) if appliesGenderMaleFemaleDate of BirthPlace of Birth School attending and current grade Religion Religious Education At schoolParish Religious Ed.OtherSacrament Baptism date and ChurchReconciliation date and Church First Eucharist date and Church Confirmation date and Church MEMBER #8 (Child 6) Member #8 Name FirstMiddleLastSuffix (if applies) if appliesGenderMaleFemaleDate of BirthPlace of Birth School attending and current grade Religion Religious Education At schoolParish Religious Ed.OtherSacrament Baptism date and Church Reconciliation date and Church First Eucharist date and Church Confirmation date and Church MEMBER #9 (Child 7) Member #9 Name FirstMiddleLastSuffix (if applies) if appliesGenderMaleFemaleDate of BirthPlace of Birth School attending and current grade Religion Religious Education At schoolParish Religious Ed.OtherSacrament Baptism date and Church Reconciliation date and Church First Eucharist date and ChurchConfirmation date and Church MEMBER #10 (Child 8) Member #10 Name FirstMiddleLastSuffix (if applies) if appliesGenderMaleFemaleDate of BirthPlace of Birth School attending and current grade Religion Religious Education At schoolParish Religious Ed.OtherSacrament Baptism date and Church Reconciliation date and Church First Eucharist date and Church Confirmation date and Church MEMBER #11 (Other Adult in household) Mr. / Mrs. / Ms. / Miss / Dr.Name FirstMiddleLastSuffix (if applies) if appliesMaiden Name (if applies)GenderMaleFemaleDate of Birth Family Role Sole Head of the HouseholdHusbandWifeMarital StatusSingleMarriedWidowedSeparatedDivorcedAnnulledEducation High School13 Yrs +AssociateBachelor’sMaster’sDoctorateOccupation Cell Phone Work Phone Personal Email ReligionSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and ChurchConfirmation date and Church MEMBER #12 (Other Adult in Household) Mr. / Mrs. / Ms. / Miss / Dr.Name FirstMiddleLastSuffix (if applies) if appliesMaiden Name (if applies) GenderMaleFemaleDate of Birth Family Role Sole Head of the HouseholdHusbandWifeMarital StatusSingleMarriedWidowedSeparatedDivorcedAnnulledEducation High School13 Yrs +AssociateBachelor’sMaster’sDoctorateOccupationCell Phone Work Phone Personal EmailReligionSacrament Baptism date and ChurchReconciliation date and ChurchFirst Eucharist date and ChurchConfirmation date and Church Submit
