PARISH REGISTRATION

Type of Registration

New Parishioner Registration

An Update to a Current Household Listing?

Family Last Name

Today's Date

Street Address

City

St.

Zip

Head of Household - Marital Status

Head of Household - First Name

Head of Household - Last Name

Head of Household - Primary Phone Number

Head of Household - Additional Phone Number

1st Head of Household - Email Address

Receive Parish Emails/Donation Statements?

Yes

No

Head of Household - Date of Birth

Head of Household - Occupation

Head of Household - Sacraments Completed

Baptism

1st Communion

Confirmation

Head of Household - Church of Baptism

City

St.

Additional Notes (If Applicable)

2nd Head of Household - Marital Status

2nd Head of Household - First Name

2nd Head of Household - Last Name/Maiden

2nd Head of Household - Primary Phone Number

2nd Head of Household - Additional Phone Number

2nd Head of Household - Email Address

Receive Parish Emails/Donation Statements?

Yes

No

2nd Head of Household - Date of Birth

2nd Head of Household - Occupation

2nd Head of Household - Sacraments Completed

Baptism

First Communion

Confirmation

2nd Head of Household - Church of Baptism

City

St.

Additional Notes (If Applicable)

Free Text

CHILDREN INFORMATION

1st Child - First Name

1st Child - Last Name

1st Child - Date of Birth

1st Child - Grade/School

1st Child - Sacraments Completed

Baptism

1st Communion

Confirmation

New Option

1st Child - Baptism Date

1st Child - Church of Baptism/City/St.

Additional Notes (If Applicable)

2nd Child - First Name

2nd Child - Last Name

2nd Child - Date of Birth

2nd Child - Grade/School

2nd Child - Sacraments Completed

Baptism

1st Communion

Confirmation

2nd Child - Baptism Date

2nd Child - Church of Baptism - Church of Baptism/City/St.

Additional Notes (If Applicable)

3rd Child - First Name

3rd Child - Last Name

3rd Child - Date of Birth

3rd Child - Grade/School

3rd Child - Sacraments Completed

Baptism

1st Communion

Confirmation

3rd Child - Baptism Date:

3rd Child - Church of Baptism - Church of Baptism/City/St.

I would like to learn more about:

Additional Notes (If Applicable)

Choose an Option:

Please register me at St. Mary Catholic Church in Bloomfield.

Please register me at St. Rose of Lima Catholic Church in Blanco.

St. Mary & St. Rose of Lima

St. Mary &

St. Rose of Lima

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