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* Indicates required question
Name (head of household) Last, First, Middle, (Maiden)
*
Your answer
Gender (Head of Houshold)
*
Male
Female
Present Street Address, City, State, Zip
*
Your answer
Mailing Address (if different)
Your answer
Home Telephone, His Cell, Her Cell, His Work, Her Work (xxx) xxx-xxxx
Your answer
SMM may publish our family name, address & phone number in the annual Church Directory
*
Yes
No
Email Address
Your answer
Family Status
Married
Single
Widowed
Divorced
Separated
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I/we attend Mass
*
Daily
Weekly
Occasionally
Seldom
Do not attend Mass
Date Married (if applicable)
Your answer
Married by a Catholic Priest or Deacon (if applicable)
Yes
No
Clear selection
Date of Birth (Head of Household)
*
Your answer
Employer (Head of Household)
Your answer
Employment Position (Head of Household)
Your answer
Religion (Head of Household)
Your answer
Sacraments Received (Head of Household)
Baptism
First Communion
Confirmation
Spouse Name: Last, First, Maiden
Your answer
Spouse Date of Birth
Your answer
Employer (Spouse)
Your answer
Employment Position (Spouse)
Your answer
Religion (Spouse)
Your answer
Sacraments Received (Spouse)
Baptism
First Communion
Confirmation
# of Children / Grandchildren living in household
*
Your answer
Child 1 First Name & Last Name
Your answer
Child 1 Gender
Male
Female
Clear selection
Child 1 Date of Birth
Your answer
Child 1 Religion
Your answer
Child 1 Sacraments Received
Baptism
First Communion
Confirmation
Clear selection
Child 1 School Attending
Your answer
Child 1 Attending SMM Religious Ed (PSR)?
Yes
No
Clear selection
Child 2 First Name & Last Name
Your answer
Child 2 Gender
Male
Female
Clear selection
Child 2 Date of Birth
Your answer
Child 2 Religion
Your answer
Child 2 Sacraments Received
Baptism
First Communion
Confirmation
Clear selection
Child 2 School Attending
Your answer
Child 2 Attending SMM Religious Ed (PSR)?
Yes
No
Clear selection
Child 3 First Name & Last Name
Your answer
Child 3 Gender
Male
Female
Clear selection
Child 3 Date of Birth
Your answer
Child 3 Religion
Your answer
Child 3 Sacraments Received
Baptism
First Communion
Confirmation
Clear selection
Child 3 School Attending
Your answer
Child 3 Attending SMM Religious Ed (PSR)?
Yes
No
Clear selection
Child 4 First Name & Last Name
Your answer
Child 4 Gender
Male
Female
Clear selection
Child 4 Date of Birth
Your answer
Child 4 Religion
Your answer
Child 4 Sacraments Received
Baptism
First Communion
Confirmation
Clear selection
Child 4 School Attending
Your answer
Child 4 Attending SMM Religious Ed (PSR)?
Yes
No
Clear selection
Child 5 First Name & Last Name
Your answer
Child 5 Gender
Male
Female
Clear selection
Child 5 Date of Birth
Your answer
Child 5 Religion
Your answer
Child 5 Sacraments Received
Baptism
First Communion
Confirmation
Clear selection
Child 5 School Attending
Your answer
Child 5 Attending SMM Religious Ed (PSR)?
Yes
No
Clear selection
Child 6 First Name & Last Name
Your answer
Child 6 Gender
Male
Female
Clear selection
Child 6 Date of Birth
Your answer
Child 6 Religion
Your answer
Child 6 Sacraments Received
Baptism
First Communion
Confirmation
Clear selection
Child 6 School Attending
Your answer
Child 6 Attending SMM Religious Ed (PSR)?
Yes
No
Clear selection
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