Parish registration I am registering for*Select belowSt. FrancisSt. LawrenceHoly Name of the Sacred Heart of JesusPrevious Parish registered at (if any) Family Name TitleSelect belowMr. & Mrs.Mr.Mrs.Ms.Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone (Landline)Husband’s Name* Date & Place of Birth Cell PhoneEmail* Occupation If retired, enter Retired. If unemployed, enter Unemployed. Marital StatusSelect belowSingleCatholic MarriageCivil MarriageSeparatedDivorcedRemarriedWidow/WidowerIf married, who were you married by? Catholic Priest or Deacon _____ Other (Justice of the Peace or Non Catholic Clergy) _____ Check those which apply Catholic Baptized First Eucharist Confirmed Where were you baptized? WifeWife’s Name Wife’s Maiden Name Wife’s Date & Place of Birth Wife’s Cell phone numberWife’s Occupation If retired, enter Retired. If unemployed, enter Unemployed. Wife's Marital StatusSelect belowSingleCatholic MarriageCivil MarriageSeparatedDivorcedRemarriedWidow/Widower(Wife) If married, who were you married by? Catholic Priest or Deacon _____ Other (Justice of the Peace or Non Catholic Clergy) _____ (Wife) Check those which apply Catholic Baptized First Eucharist Confirmed (Wife) Where was she baptized? ChildrenChlid #1 Name Chlid #1 Date & Place of Birth Chlid #1 School attending Chlid #1 Grade Child #1 Check those which apply Catholic Baptized First Eucharist Confirmed Child #1 Where were they baptized? Chlid #2 Name Chlid #2 Date & Place of Birth Chlid #2 School attending Chlid #2 Grade Child #2 Check those which apply Catholic Baptized First Eucharist Confirmed Child #2 Where were they baptized? Chlid #3 Name Chlid #3 Date & Place of Birth Chlid #3 School attending Chlid #3 Grade Child #3 Check those which apply Catholic Baptized First Eucharist Confirmed Child #3 Where were they baptized? Other persons living at this addressOther Person #1 Name Other Person #1 Relationship Other Person #1 Date & Place of Birth Other Person #1 Cell phone numberOther person #1 Email Other Person #1 Occupation If retired, enter Retired. If unemployed, enter Unemployed. Other Person #1 Marital StatusSelect belowSingleCatholic MarriageCivil MarriageSeparatedDivorcedRemarriedWidow/WidowerOther Person #1 If married, who were they married by? Catholic Priest or Deacon _____ Other (Justice of the Peace or Non Catholic Clergy) _____ Other Person #1 Check those which apply Catholic Baptized First Eucharist Confirmed Other Person #1 Where were they baptized? Other Person #2 Name Other Person #2 Relationship Other Person #2 Date & Place of Birth Other Person #2 Cell phone numberOther person #2 Email Other Person #2 Occupation If retired, enter Retired. If unemployed, enter Unemployed. Other Person #2 Marital StatusSelect belowSingleCatholic MarriageCivil MarriageSeparatedDivorcedRemarriedWidow/WidowerOther Person #2 If married, who were they married by? Catholic Priest or Deacon _____ Other (Justice of the Peace or Non Catholic Clergy) _____ Other Person #2 Check those which apply Catholic Baptized First Eucharist Confirmed Other Person #2 Where were they baptized? Other Person #3 Name Other Person #3 Relationship Other Person #3 Date & Place of Birth Other Person #3 Cell phone numberOther person #3 Email Other Person #3 Occupation If retired, enter Retired. If unemployed, enter Unemployed. Other Person #3 Marital StatusSelect belowSingleCatholic MarriageCivil MarriageSeparatedDivorcedRemarriedWidow/WidowerOther Person #3 If married, who were they married by? Catholic Priest or Deacon _____ Other (Justice of the Peace or Non Catholic Clergy) _____ Other Person #3 Check those which apply Catholic Baptized First Eucharist Confirmed Other Person #3 Where were they baptized? Anyone at home prevented from attending Church due to illness of handicap?Select belowYesNoAnyone at home who would want a visit from a Priest/Eucharistic Minister?Select belowYesNoCommentsThis field is for validation purposes and should be left unchanged.
