Saint Raphael New Parishioner Registration
We're so excited to welcome you into our Parish Family! If you have more than 2 adult members, or more than 3 child members in your family, please submit a second form. If you have any questions, please call the Parish Center at 412-661-3100.

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Family Name
Your answer
Preferred Way to Address Mail
Home Address
Your answer
City, State, Zip Code
Your answer
Home Phone Number
(XXX) XXX-XXXX
Your answer
Email Address
Your answer
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We are interested in learning more about the following ministries:
Adult Member #1 (Head of Household)
18 years or older
Data Code
Current Marital Status
First Name, Middle Name
Your answer
Maiden Name (if applicable)
Your answer
Sex
Birthday
XX/XX/XXXX
Your answer
Address, if different than above
Your answer
Cell Phone
(XXX) XXX-XXXX
Your answer
Occupation
Your answer
Work Phone Number
(XXX) XXX-XXXX
Your answer
What is your baptismal status?
If baptized, please list date/location
Your answer
Have you received your First Communion?
If yes, date/location
Your answer
Have you received the sacrament of Confirmation?
If yes, date/location
Your answer
If married, date and location of wedding
Your answer
How often do you attend Mass?
Adult Member #2
18 years or older
Data Code
Current Marital Status
First Name, Middle Name
Your answer
Maiden Name (if applicable)
Your answer
Sex
Birthday
XX/XX/XXXX
Your answer
Address, if different than above
Your answer
Cell Phone
(XXX) XXX-XXXX
Your answer
Occupation
Your answer
Work Phone Number
(XXX) XXX-XXXX
Your answer
What is your baptismal status?
If baptized, please list date/location
Your answer
Have you received your First Communion?
If yes, date/location
Your answer
Have you received the sacrament of Confirmation?
If yes, date/location
Your answer
If married, date and location of wedding
Your answer
How often do you attend Mass?
Child Member #1
17 years or younger
Data Code
First Name, Middle Name
Your answer
Sex
Birthday
(XX/XX/XXXX)
Your answer
Age
Your answer
School
Your answer
Grade
Your answer
What is the child's baptismal status?
If baptized, date/location
Your answer
Has the child received his/her First Communion?
If yes, date/location
Your answer
Has the child been confirmed?
If yes, date/location
Your answer
Child Member #2
17 years or younger
Data Code
First Name, Middle Name
Your answer
Sex
Birthday
(XX/XX/XXXX)
Your answer
Age
Your answer
School
Your answer
Grade
Your answer
What is the child's baptismal status?
If baptized, date/location
Your answer
Has the child received his/her First Communion?
If yes, date/location
Your answer
Has the child been confirmed?
If yes, date/location
Your answer
Child Member #3
17 years or younger
Data Code
First Name, Middle Name
Your answer
Sex
Birthday
(XX/XX/XXXX)
Your answer
Age
Your answer
School
Your answer
Grade
Your answer
What is the child's baptismal status?
If baptized, date/location
Your answer
Has the child received his/her First Communion?
If yes, date/location
Your answer
Has the child been confirmed?
If yes, date/location
Your answer
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