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  • Are you a new family? Yes No
  • Family Last Name Please enter valid data.
  • Envelope Number Please enter valid data.
  • How long have you been attending our Church? Please enter valid data.
  • Address Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Preferred Mailing Name Please enter valid data.
  • Head of Household
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Education/Degree Please enter valid data.
  • Occupation Please enter valid data.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Spouse Information
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Education/Degree Please enter valid data.
  • Occupation Please enter valid data.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Marital Status Married Single Widowed Divorced Separated
  • Were you sacramentally married in the Catholic Church? None Yes No N/A
  • Marriage Date REQUIRED Please fill out this field. Please enter a date.
  • May we provide information on: None Sacramental Marriage Annulment
  • Number of Children in Family Please enter an integer (number).
  • Child 1
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Living at home? Please enter valid data.
  • School or daycare attending now Please enter valid data.
  • Grade Daycare Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade High School College
  • Child 2
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Living at home? Please enter valid data.
  • School or daycare attending now Please enter valid data.
  • Grade Daycare Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade High School College
  • Child 3
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Living at home? Please enter valid data.
  • School or daycare attending now Please enter valid data.
  • Grade Daycare Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade High School College
  • Child 4
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Living at home? Please enter valid data.
  • School or daycare attending now Please enter valid data.
  • Grade Daycare Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade High School College
  • Child 5
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Living at home? Please enter valid data.
  • School or daycare attending now Please enter valid data.
  • Grade Daycare Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade High School College
  • Child 6
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Religion Please enter valid data.
  • Ethnicity Please enter valid data.
  • Sacraments Baptism Penance Communion Confirmation Matrimony Holy Orders
  • Please list the Church, Location, and Date
  • Living at home? Please enter valid data.
  • School or daycare attending now Please enter valid data.
  • Grade Daycare Pre-K Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade High School College
  • May we provide information regarding Baptism, Reconciliation, Holy Eucharist, and Confirmation for those in the family who have not yet received these sacraments? None Yes No Not at this time
  • Do you wish to be added to our envelope system? None Yes No Not at this time
  • Would you prefer to participate in On-Line Giving? None Yes No Not at this time
  • Do you know how you might like to volunteer at our Parish? Please enter valid data.
  • Ministries Family Members may be interested in: Please enter valid data.
  • Skills and Talents family members may be able to offer to the parish: Please enter valid data.
  • What brings you to Our Parish at this time? Please enter valid data.
  • Additional Information: Please enter valid data.
  • Annual Block Collection Please enter valid data.

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