Parish Registration
St. Elizabeth Ann Seton Parish - Salina, KS
Family Name *
Your answer
Primary Phone *
Your answer
Address *
Your answer
City, State Zip *
Your answer
Adults in the Home
Head of Household Name *
Your answer
HoH-Date of Birth *
MM
/
DD
/
YYYY
HoH-Gender *
HoH-Religion *
Your answer
HoH-Occupation and Name of Business/Employer
Your answer
HoH-Cell Phone
Your answer
HoH-Email Address
Your answer
HoH-Sacraments *
Yes
No
Baptism
1st Communion
Confirmation
HoH-Location and Date of Sacraments
if available
Your answer
Marital Status
Date of Marriage
MM
/
DD
/
YYYY
Location of Marriage
Your answer
Spouse/Second Adult
include maiden name
Your answer
S-Date of Birth
MM
/
DD
/
YYYY
S-Gender
S-Religion
Your answer
S-Occupation and Name of Business/Employer
Your answer
S-CellPhone
Your answer
S- Email
Your answer
S-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
S-Location and Date of Sacraments
if available
Your answer
Third Adult
Your answer
A-Date of Birth
MM
/
DD
/
YYYY
A-Gender
A-Religion
Your answer
A-Occupation and Name of Business/Employer
Your answer
A-CellPhone
Your answer
A-Email Address
Your answer
A-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
A-Location and Date of Sacraments
if available
Your answer
Children Living at Home
Child 1 - Full Name
Your answer
1-Date of Birth
MM
/
DD
/
YYYY
1-Gender
1-Religion
Your answer
1-School
Your answer
1-Grade
Your answer
1-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
1-Location and Date of Sacraments
if available
Your answer
Child 2 - Full Name
Your answer
2-Date of Birth
MM
/
DD
/
YYYY
2-Gender
2-Religion
Your answer
2-School
Your answer
2-Grade
Your answer
2-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
2-Location and Date of Sacraments
if available
Your answer
Child 3 - Full Name
Your answer
3-Date of Birth
MM
/
DD
/
YYYY
3-Gender
3-Religion
Your answer
3-School
Your answer
3-Grade
Your answer
3-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
3-Location and Date of Sacraments
if available
Your answer
Child 4 - Full Name
Your answer
4-Date of Birth
MM
/
DD
/
YYYY
4-Gender
4-Religion
Your answer
4-School
Your answer
4-Grade
Your answer
4-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
4-Location and Date of Sacraments
if available
Your answer
Child 5 - Full Name
Your answer
5-Date of Birth
MM
/
DD
/
YYYY
5-Gender
5-Religion
Your answer
5-School
Your answer
5-Grade
Your answer
5-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
5-Location and Date of Sacraments
if available
Your answer
Child 6 - Full Name
Your answer
6-Gender
6-Religion
Your answer
6-School
Your answer
6-Grade
Your answer
6-Sacraments
Yes
No
Baptism
1st Communion
Confirmation
6-Location and Date of Sacraments
if available
Your answer
Other Information
Preference for parish financial contributions
Former Parish
Name of Church/Parish and Location (City, State)
Your answer
Are there any special needs of any person in this household? (Yes or No, and more information as necessary)
Your answer
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