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Page 1 of 3 Parish Registration Form Date Registering:Family Name*Address*City*State*Please selectWisconsinAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict Of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWyomingZip Code*Primary Phone Number:*Type:HomeMobileAlternate Number:Type:HomeMobileEmail address*Send Email Instead of Mail, When Possible.YesNoPlease Do NOT Share My Personal Information.Do Not ShareWould you like to receive our Flocknote emails?*YesNoWhat method of contributions to the church would you prefer? *EnvelopesOnlinePermission is granted to use photos taken of me or my family on parish-based communication platforms.*YesNo Head of Household / Primary Adult Member Information Name:*Please selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixBirth Date:Gender:MaleFemaleMarital Status (Choose One):EngagedMarriedSeparatedDivorcedSingleSingle with Child(ren)WidowWidowerEthnicity (Choose One):African AmericanAsianHispanic or LatinoNative AmericanPacific IslanderWhiteEmail address:Language:(Indicate if other than English)Religion:CatholicChristianLutheranMethodistPenecostalPresbyterianNon-CatholicNon-DenominationalOtherSacraments (Check All that Apply):*BaptismCommunionConfirmationNoneOccupation:Areas of Interest(Check ALL that you are interested in)AdorationAltar ServerBereavementBuilding and GroundsChristian FormationChristian WomenEngagement CommitteeFinanceFish FriesHome VisitsHospitalityHuman ConcernsLiturgicalMusic MinistryPastoralPrayer ShawlSandwich MinistrySheepsheadSt Ben'sSt Vincent De PaulNextClick here to move on to the next page. Spouse/Second Adult Member Information Is there a second adult household member?*YesNoName:Please selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixBirth Date:Gender:MaleFemalePrimary Phone Number:Type:HomeMobileAlternate Number:Type:HomeMobileMarital Status (Choose One):EngagedMarriedSeparatedDivorcedSingleSingle with Child(ren)WidowWidowerEthnicity (Choose One):African AmericanAsianHispanic or LatinoNative AmericanPacific IslanderWhiteLanguage:(Indicate if other than English)Religion:CatholicChristianLutheranMethodistPenecostalPresbyterianNon-CatholicNon-DenominationalOtherOccupation:Areas of Interest(Check ALL that you are interested in)AdorationAltar ServerBereavementBuilding and GroundsChristian FormationChristian WomenEngagement CommitteeFinanceFish FriesHome VisitsHospitalityHuman ConcernsLiturgicalMusic MinistryPastoralPrayer ShawlSandwich MinistrySheepsheadSt Ben'sSt Vincent De PaulBackNextClick "Next" to move on to the next page, or "Back" to return to the first page. Children / Dependents in Your Household How many children or dependents do you have in your household?*Please select012345678910 First Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Second Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Third Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Fourth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Fifth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Sixth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Seventh Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Eighth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Ninth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmation Tenth Child Information Child NamePlease selectMrMrsMsMissDrPrefixFirstMiddleLastSuffixChild Birth DateChild GenderMaleFemaleSacraments (Check All that Apply):BaptismCommunionConfirmationBackSendClick "Send" to finish and send the form, or "Back" to return to the first page.This field should be left blank
