Divine Mercy Parish Registration Form
Title *
Last Name *
Your answer
First Name & Middle or Maiden *
Your answer
Sex *
Required
Birthdate *
Your answer
Address *
Your answer
City *
Your answer
State *
Your answer
Zip *
Your answer
Home Phone *
Your answer
Cell Phone *
Your answer
Work Phone
Your answer
Email Address *
Your answer
Fax #
Your answer
Marital Status
Your answer
Wedding Date
Your answer
Catholic Wedding *
Required
Occupation
Your answer
Employer
Your answer
Catholic *
Required
Baptized *
Required
Date of Baptism
Your answer
Confirmation *
Required
Date of Confirmation
Your answer
Spouse Information
Title
Last Name
Your answer
First Name & Middle or Maiden
Your answer
Sex
Birthdate
Your answer
City
Your answer
State
Your answer
Zip
Your answer
Home Phone
Your answer
Cell Phone
Your answer
Work Phone
Your answer
Fax #
Your answer
Marital Status
Your answer
Wedding Date
Your answer
Catholic Wedding
Occupation
Your answer
Employer
Your answer
Catholic
Baptized
Baptism Date
Your answer
Confirmation
Confirmation Date
Your answer
Children Living at Home
Please include the following of all of your children living at home:
Name (first, middle, last), Birthdate, Male/Female, Catholic, Baptized (Y,N), Baptism Date, Confirmed (Y,N), Confirmation Date, Grade, Norte Dame Student (Y,N)
Your answer
Additional Comments or Questions
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