2013 Parish Census

Family Name

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Home Address

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Home Phone Number

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Are there people in the household who are homebound or sick that would like to receive Holy Communion at home on a monthly basis?

Yes
No

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Would you like Father Chris or Deacon Bill to contact you and arrange a visit to your home for a "Home Blessing" and pastoral visit?

Yes
No

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Is anyone in the household interested in becoming more involved in one of our ministries or perhaps starting a new ministry/group at this time (you will be contacted to help you discern where your gifts might best be used for the parish)?

Yes
No

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Can you offer suggestions for ways we can improve our parish so that we will remain an amazing place where God is glorified and His people are sanctified (we really want to get as much feedback and ideas from people as possible)?

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Regarding envelopes that we use for our weekly tithe...

I receive them with no problems
I receive them but sometimes there are problems and they do not come
I do not receive them nor do I want to receive them
I do not receive them but would like to begin receiving them

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First and Last Name for Head of Household

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Date of Birth for Head of Housebold

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Cell Phone for Head of Household

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Email address for Head of Household

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Is the Head of Household a Catholic?

Yes
No
No, but interested in becoming a Catholic

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Has Head of Household received Baptism, Confirmation & Eucharist?

Yes
No
Unsure at this time

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Is Head of Household working or in school? Where/what are they doing?

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First and Last Name for Person #2

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Date of Birth for Person #2

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Cell Phone Number for Person #2

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Email address for Person #2

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is Person #2 a Catholic?

Yes
No
No, but interested in becoming Catholic

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Has Person #2 received Baptism, Confirmation & Eucharist?

Yes
No
Unsure at this time

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Is Person #2 working or in school? Where/what are they doing?

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First and Last Name for Person #3

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Date of Birth for Person #3

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Cell Phone Number for Person #3

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Email address for Person #3

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Is Person #3 a Catholic?

Yes
No
No, but interested in becoming a Catholic

This is a required question

Has Person #3 received the Sacraments of Baptism, Confirmation & Eucharist?

Yes
No
Unsure at this time

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Is Person #3 in school or working? Where/what are they doing?

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First and Last Name for Person #4

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Date of Birth for Person #4

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Cell Phone Number for Person #4

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Email address for Person #4

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Is Person #4 a Catholic?

Yes
No
No, but interested in becoming Catholic

This is a required question

Has Person #4 received Baptism, Confirmation & Eucharist?

Yes
No
Unsure at this time

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Is Person #4 working or going to school at this time? Where/what are they doing?

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First and Last Name for Person #5

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Date of Birth for Person #5

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Cell Phone Number for Person #5

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Email address for Person #5

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Is Person #5 a Catholic?

Yes
No
No, but interested in becoming a Catholic

This is a required question

Has Person #5 received the Sacraments of Baptism, Confirmation & Eucharist?

Yes
No
Unsure at this time

This is a required question

Is Person #5 working or going to school at this time? Where/what are they doing?

This is a required question