St. Nick's Registration Form
St. Nicholas of Myra Catholic Church
Preferred Mass Time
Member of Catholic School
Required
Head of Household
First & Last Name
Your answer
Maiden Name (if married)
Your answer
Address
Your answer
City, State Zip
Your answer
Gender
Date of Birth
MM
/
DD
/
YYYY
Home Phone
Your answer
Unlisted
Work Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Occupation
Your answer
Preferred mode of contact
Member of Catholic Faith
Spouse
First & Last Name
Your answer
Maiden Name
Your answer
Date of Marriage
MM
/
DD
/
YYYY
Gender
Date of Birth
MM
/
DD
/
YYYY
Home Phone
Your answer
Work Phone
Your answer
Cell Phone
Your answer
Email
Your answer
Occupation
Your answer
Preferred mode of contact
Member of Catholic Faith
Previous Parish
Your answer
Time, Talent & Treasure
There are many ways you can contribute to our parish community. As a member of our church, you are welcome to join various ministries and committees. Please indicate your interest to serve in these areas
Committees and Commissions
Participation in Mass
Estimated Yearly Tithe: $_______
Your answer
Tithe frequency
Required
Children
Please list all children in your family, including college-aged children – they are an important part of our parish community!
Child 1 First/Middle/Last Name
Your answer
Child 1 Date of Birth
MM
/
DD
/
YYYY
Child 1 Gender
Child 1 School/Grade
Your answer
Child 1 Baptized
MM
/
DD
/
YYYY
Child 1 Reconciliation
MM
/
DD
/
YYYY
Child 1 First Communion
MM
/
DD
/
YYYY
Child 1 Confirmation
MM
/
DD
/
YYYY
Child 2 First/Middle/Last Name
Your answer
Child 2 Date of Birth
MM
/
DD
/
YYYY
Child 2 Gender
Child 2 School/Grade
Your answer
Child 2 Baptized
MM
/
DD
/
YYYY
Child 2 Reconciliation
MM
/
DD
/
YYYY
Child 2 First Communion
MM
/
DD
/
YYYY
Child 2 Confirmation
MM
/
DD
/
YYYY
Child 3 First/Middle/Last Name
Your answer
Child 3 Date of Birth
MM
/
DD
/
YYYY
Child 3 Gender
Child 3 School/Grade
Your answer
Child 3 Baptized
MM
/
DD
/
YYYY
Child 3 Reconciliation
MM
/
DD
/
YYYY
Child 3 First Communion
MM
/
DD
/
YYYY
Child 3 Confirmation
MM
/
DD
/
YYYY
Child 4 First/Middle/Last Name
Your answer
Child 4 Date of Birth
MM
/
DD
/
YYYY
Child 4 Gender
Child 4 School/Grade
Your answer
Child 4 Baptized
MM
/
DD
/
YYYY
Child 4 Reconciliation
MM
/
DD
/
YYYY
Child 4 First Communion
MM
/
DD
/
YYYY
Child 4 Confirmation
MM
/
DD
/
YYYY
Child 5 First/Middle/Last Name
Your answer
Child 5 Date of Birth
MM
/
DD
/
YYYY
Child 5 Gender
Child 5 School/Grade
Your answer
Child 5 Baptized
MM
/
DD
/
YYYY
Child 5 Reconciliation
MM
/
DD
/
YYYY
Child 5 First Communion
MM
/
DD
/
YYYY
Child 5 Confirmation
MM
/
DD
/
YYYY
Child 6 First/Middle/Last Name
Your answer
Child 6 Date of Birth
MM
/
DD
/
YYYY
Child 6 Gender
Child 6 School/Grade
Your answer
Child 6 Baptized
MM
/
DD
/
YYYY
Child 6 Reconciliation
MM
/
DD
/
YYYY
Child 6 First Communion
MM
/
DD
/
YYYY
Child 6 Confirmation
MM
/
DD
/
YYYY
Child 7 First/Middle/Last Name
Your answer
Child 7 Date of Birth
MM
/
DD
/
YYYY
Child 7 Gender
Child 7 School/Grade
Your answer
Child 7 Baptized
MM
/
DD
/
YYYY
Child 7 Reconciliation
MM
/
DD
/
YYYY
Child 7 First Communion
MM
/
DD
/
YYYY
Child 7 Confirmation
MM
/
DD
/
YYYY
Additional Information
Is there anything specific we can do to assist you as you join our parish?
Your answer
Thank you!
A parish member will be contacting you within the next four to six weeks to explain the various parish activities and opportunities to get involved.
Would you like a parish member to visit you?
If yes, where?
May we publish your name in the St. Nicholas Bulletin?
Submit
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