Parish Registration Form

Census/Registration Form

Please select Church of Registration(Required)

Address(Required)

Street Address PO Box (If any) City State ZIP Code

Date(Required)

Would you like to receive parish donation envelopes?(Required)

Yes

How would you like to receive your diocesan newspaper subscription?(Required)

Mail to My House

Emailed to Me

No thank you

Email to receive newspaper.

First Head of Household

List Members Separate (First & Last)

First Head of Household Name(Required)

First Last

First Head of Household Date of Birth(Required)

First Head of Household Religion(Required)

Example Catholic

First Head of Household Sacraments(Required)

Baptized

1st Communion

Confirmed

None

Select those that apply

First Head of Household Email(Required)

First Head of Household Home #

First Head of Household Cell #(Required)

First Head of Household Place of Employment

First Head of Household Work #

Is there a second Head of Household Member?(Required)

Yes

Second Head of Household

List Member Separate (First & Last)

Second Head of Household Name

First Last

Second Head of Household Date of Birth

Second Head of Household Religion

Example Catholic

Second Head of Household Sacraments

Baptized

1st Communion

Confirmed

None

Select those that apply

Second Head of Household Email

Second Head of Household Home #

Second Head of Household Cell #

Second Head of Household Place of Employment

Second Head of Household Work #

Children and Others in Household

Are there others in your household?(Required)

Yes

Household Other Member #1

Household Member 1 Name

First Last

Household Member 1 Gender

Female

Male

Household Member 1 Date of Birth

Household Member 1 Religion

Example Catholic

Household Member 1 Sacraments

Baptized

1st Communion

Confirmation

None

Household Member 1 Student?

Yes

Household Member 1 Grade Level

Is there a second household member?

Yes

Household Other Member #2

Household Member 2 Name

First Last

Household Member 2 Gender

Female

Male

Household Member 2 Date of Birth

Household Member 2 Religion

Example Catholic

Household Member 2 Sacraments

Baptized

1st Communion

Confirmation

None

Household Member 2 Student?

Yes

Household Member 2 Grade Level

Is there a third household member?

Yes

Household Other Member #3

Household Member 3 Name

First Last

Household Member 3 Gender

Female

Male

Household Member 3 Date of Birth

Household Member 3 Religion

Example Catholic

Household Member 3 Sacraments

Baptized

1st Communion

Confirmation

None

Household Member 3 Student?

Yes

Household Member 3 Grade Level

Is there a fourth household member?

Yes

Household Other Member #4

Household Member 4 Name

First Last

Household Member 4 Gender

Female

Male

Household Member 4 Date of Birth

Household Member 4 Religion

Example Catholic

Household Member 4 Sacraments

Baptized

1st Communion

Confirmation

None

Household Member 4 Student?

Yes

Household Member 4 Grade Level

Is there a fifth household member?

Yes

Household Other Member #5

Household Member 5 Name

First Last

Household Member 5 Gender

Female

Male

Household Member 5 Date of Birth

Household Member 5 Religion

Example Catholic

Household Member 5 Sacraments

Baptized

1st Communion

Confirmation

None

Household Member 5 Student?

Yes

Household Member 5 Grade Level

Is there a sixth household member?

Yes

Household Other Member #6

Household Member 5 Name

First Last

Household Member 6 Gender

Female

Male

Household Member 6 Date of Birth

Household Member 6 Religion

Example Catholic

Household Member 6 Sacraments

Baptized

1st Communion

Confirmation

None

Household Member 6 Student?

Yes

Household Member 6 Grade Level

Status information

Please check appropriate status(Required)

If status is "Other" please explain

Married Information

If Married, Date

Place of Wedding (Church, City, State)

Church City State

Wife's Maiden Name

In Catholic Church?

Yes

If no, was permission granted by Bishop?

Yes

If no, would you like to have your marriage Convalidated or Blessed?

Yes

Census/Registration Form

First Head of Household

Second Head of Household

Children and Others in Household

Household Other Member #1

Household Other Member #2

Household Other Member #3

Household Other Member #4

Household Other Member #5

Household Other Member #6

Status information

Married Information

PARISH ADMINISTRATION OFFICE

Address / Phone:

Email:

Hours: