Step 1 of 2 – Family Information 50% Today's Date* MM slash DD slash YYYY Family Last Name* Title*If you are single, please only check one. For families, check two. Dr. Mr. Mrs. Miss Ms Mailing Label* Home Phone*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 Family Email* Secondary Email Were you registered here before?* Yes No When?* Household is:* Single Parent Married Parents Marriage InformationChurch* Address* City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date* MM slash DD slash YYYY Household Information1st Adult is:* Father/Male Mother/Female Name* First Last Date of Birth* MM slash DD slash YYYY Maiden Name* Primary Language* Religion* Sacraments Received Baptism Confirmation Employment/Occupation Cell PhoneWork PhoneSpouse InformationSpouse is* Father/Male Mother/Female Name* First Last Date of Birth* MM slash DD slash YYYY Maiden Name* Primary Language* Religion* Sacraments Received Baptism Confirmation Employment/Occupation Cell Phone*Work Phone*Other AdultPlease only include adult that is currently living with you. Other Adult is Male Female Name First Last Date of Birth MM slash DD slash YYYY Primary Language Religion Sacraments Received Baptism Confirmation Marital Status Single Widowed Separated Divorced Employment/Occupation Cell PhoneWork PhoneAre you or a member of your household interested in becoming involved in a ministry within our parish?*If you select Yes, you will be directed to our Ministry Interest Form after submission! Yes No Add Children?*(Children must be under 18 and living with you) Yes No First ChildChild's Name* First Last Child is* Male Female Date of Birth* MM slash DD slash YYYY Primary Language Religion Sacrament's Received Baptism Reconciliation Eucharist Confirmation Name of School Grade EnteringPlease enter a number from 1 to 12.Second ChildDate of Birth MM slash DD slash YYYY Child's Name First Last Child is Male Female Primary Language Religion Sacrament's Received Baptism Reconciliation Eucharist Confirmation Name of School Grade EnteringPlease enter a number from 1 to 12.Third ChildChild's Name First Last Child is Male Female Date of Birth MM slash DD slash YYYY Primary Language Religion Sacrament's Received Baptism Reconciliation Eucharist Confirmation Name of School Grade EnteringPlease enter a number from 1 to 12.Fourth ChildChild's Name First Last Date of Birth MM slash DD slash YYYY Child is Male Female Primary Language Religion Sacrament's Received Baptism Reconciliation Eucharist Confirmation Name of School Grade EnteringPlease enter a number from 1 to 12.Fifth ChildChild's Name First Last Date of Birth MM slash DD slash YYYY Child is Male Female Primary Language Religion Sacrament's Received Baptism Reconciliation Eucharist Confirmation Name of School Grade EnteringPlease enter a number from 1 to 12.Date MM slash DD slash YYYY CAPTCHA
