Parish Registration

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Address Please enter valid data.

Address Line 2 Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Home Phone Please enter a phone number.

Check if home phone is unlisted. Please select this field.

Adult 1

Full Name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Place of Birth Please enter valid data.
Employer Please enter valid data.
Education Please enter valid data.

Adult 2 (if applicable)

Full Name (first, middle, last) REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Place of Birth Please enter valid data.
Employer Please enter valid data.
Education Please enter valid data.

Marital Status

For married couples, were you married by a:

For married couples, date and place of marriage Please enter valid data.

Please provide information about a third member of your household (if applicable): Full name, relationship, date of birth, male/female

Please provide information about a fourth member of your household (if applicable): Full name, relationship, date of birth, male/female

Please provide information about a fifth member of your household (if applicable): Full name, relationship, date of birth, male/female

Please provide information about a sixth member of your household (if applicable): Full name, relationship, date of birth, male/female

Please provide information about a seventh member of your household (if applicable): Full name, relationship, date of birth, male/female

Please provide information about a eighth member of your household (if applicable): Full name, relationship, date of birth, male/female

Is anyone in your household looking to receive (please check all that apply): Baptism (under 5) Baptism (over age 5) First Communion Confirmation (in high school) Confirmation (adult) A member of our household is homebound and would like to receive holy communion

Would you like to receive an envelope number? REQUIRED Yes No Please fill out this field.

Would you like to receive envelopes? (Alternatively, online giving can be set up on our website) REQUIRED Yes No Please fill out this field.