New Parishioner Registration Form
Please fill out this form to start your registration at our parish.
Registrant Name
Family (Last) Name *
Your answer
First Name & Middle Initial: *
Your answer
Preferred Name
Your answer
Spouse Name
If applicable
First Name & Middle Initial:
Your answer
Preferred Name
Your answer
Last Name (if different)
Your answer
Maiden Name
Your answer
Registrant Contact Information
Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Home Phone Number
Your answer
Publish Address and Home Phone Number in Printed Directory?: *
Publish Address and Home Phone Number Online?: *
Cell Phone Number *
Your answer
Cell Phone Number *
Check all that apply
Required
Email Address
Your answer
Email Address
Check all that apply
Spouse Contact Information
If applicable
Cell Phone Number
Your answer
Cell Phone Number
Check all that apply
Spouse's Email Address
Your answer
Spouse's Email Address
Check all that apply
Registrant Personal Information
Date of Birth: *
MM
/
DD
/
YYYY
Marital Status *
Marriage witnessed by Catholic Priest or Deacon?
Date of Marriage, if applicable:
MM
/
DD
/
YYYY
Sacraments Received:
Religion *
If "Other," please state Religion:
Your answer
Secondary Language *
Your answer
Occupation *
Your answer
Employer Name *
Your answer
Work Phone Number *
Your answer
Spouse Personal Information
If applicable
Date of Birth:
MM
/
DD
/
YYYY
Sacraments Received:
Marriage witnessed by Catholic Priest or Deacon?
Religion
If "Other," please state Religion:
Your answer
Secondary Language
Your answer
Occupation
Your answer
Employer Name
Your answer
Work Phone Number
Your answer
Dependent Information (Living at Home)
If registering after June 1, please indicate grade level entering in the Fall.
Please list Name (include Last Name if different), Gender, Date of Birth, Grade, School, Religion, and dates of Baptism/Communion/Confirmation (if applicable)
Your answer
Please note any Special Needs:
Your answer
Emergency Contact Name:
Your answer
Emergency Contact Relationship:
Your answer
Emergency Contact Phone Number:
Your answer
Other
Previous Parish of Registration
Your answer
City/State of Previous Parish
Your answer
Do you wish to subscribe to the Diocesan newspaper The Observer? *
Do you wish to receive Envelopes?: *
Do you wish to do Online Giving?: *
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms