Parish Registration Form
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Last Name *
First Name *
Are You Currently a Roman Catholic? *
Address Line 1 *
Street Address, P.O. Box
Address Line 2
Apartment, Building, Suite, etc.
City *
State *
Zip Code *
Home Phone Number *
Email Address *
Marital/Engagement  Status *
If married, where?
Parish, City, State
Anniversary Date
Number of Children
Member Information
Head of Household *
First Name, Middle Initial, Last Name (Maiden Name)
Date of Birth *
*
Sacraments Received *
Required
Spouse
First Name, Middle Initial, Last Name (Maiden Name)
Date of Birth
Sacraments Received
Child 1
First Name, Middle Initial, Last Name
Date of Birth
 
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Sacraments Received
Child 2
First Name, Middle Initial, Last Name
Date of Birth
 
Clear selection
Sacraments Received
Child 3
First Name, Middle Initial, Last Name
Date of Birth
 
Clear selection
Sacraments Received
Child 4
First Name, Middle Initial, Last Name
Date of Birth
 
Clear selection
Sacraments Received
Child 5
First Name, Middle Initial, Last Name
Date of Birth
 
Clear selection
Sacraments Received
More Children
please include full names and Sacraments received
Submit
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