Register for RCIA

Full Name*

First Middle Last

Address*

Street Address City State ZIP Code

Best phone number to reach you:*

Best email to reach you:*

Birthdate*

City and State where you were born*

Have you been baptized?*

I was baptized in a...*

Baptismal Name (this is the name you were baptized with)*

First Middle Last

Date of your Baptism:*

Use today's date if you are unsure of date of baptism

Name of Church, City & State where you were Baptized along with the year:*

If you were baptized in the Catholic Church, check all other Sacraments you have received as well:*

choose NONE if you were not baptized in the Catholic faith.

Discussions

What, if any, is your present religious affiliation?*

What or who has led you to want to know more about the Catholic faith?*

Please describe the types of religious education you have received, as a child and as an adult.*

What contact have you had with the Catholic Church to-date?*

What are your main questions or concerns about the Catholic Church?*

At this point in time, which of the following statements best describes you?*

I need much more information before I would consider joining.
I am considering joining but, I am unsure and would like to meet with someone to discuss my questions.
I want to join the Catholic Church.
I am a registered member of the 4 Parishes/1 Faith Catholic Cluster and would like to fully join the Catholic Faith.

Signature*

Date*

Please NOTE: There is $100.00 fee for non-members to attend our RCIA classes that is due prior to the first session.*

Yes, I am registered or will be getting registered with one of the Cluster Parishes.
No, I'm not registered (or I am registered with a Parish outside of the Cluster) and I understand that there is a $100.00 fee.

Total

$0.00

Credit Card

Card Details

Cardholder Name