Step 1 of 2 - Family Information 50% Today's Date* Date Format: 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Family Email* Secondary Email Were you registered here before?*YesNoWhen?*Household is:*Single ParentMarried ParentsMarriage InformationChurch*Address* City State / Province / Region AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date* Date Format: MM slash DD slash YYYY Head of Household InformationHead of Household is*Father/MaleMother/FemaleName* First Last Date of Birth Date Format: MM slash DD slash YYYY Maiden Name*Religion*Sacraments Received Baptism Confirmation Employment/OccupationCell PhoneWork PhoneSpouse InformationSpouse is*Father/MaleMother/FemaleName* First Last Date of Birth Date Format: MM slash DD slash YYYY Maiden Name*Religion*Sacraments Received Baptism Confirmation Employment/OccupationCell Phone*Work Phone*Other AdultPlease only include adult that is currently living with you. Other Adult isMaleFemaleName First Last Date of Birth Date Format: MM slash DD slash YYYY ReligionSacraments Received Baptism Confirmation Marital StatusSingleWidowedSeparatedDivorcedEmployment/OccupationCell PhoneWork PhoneAdd Children?*(Children must be under 18 and living with you)YesNo First ChildChild's Name* First Last Child is*MaleFemaleDate of Birth Date Format: MM slash DD slash YYYY Religion*Sacrament's Received Baptism Reconciliation Eucharist Confirmation Name of School*Grade Entering*Please enter a number from 1 to 12.Second ChildDate of Birth Date Format: MM slash DD slash YYYY Child's Name First Last Child isMaleFemaleReligionSacrament's Received Baptism Reconciliation Eucharist Confirmation Name of SchoolGrade EnteringPlease enter a number from 1 to 12.Third ChildChild's Name First Last Child isMaleFemaleDate of Birth Date Format: MM slash DD slash YYYY ReligionSacrament's Received Baptism Reconciliation Eucharist Confirmation Name of SchoolGrade EnteringPlease enter a number from 1 to 12.Fourth ChildChild's Name First Last Date of Birth Date Format: MM slash DD slash YYYY Child isMaleFemaleReligionSacrament's Received Baptism Reconciliation Eucharist Confirmation Name of SchoolGrade EnteringPlease enter a number from 1 to 12.Fifth ChildChild's Name First Last Date of Birth Date Format: MM slash DD slash YYYY Child isMaleFemaleReligionSacrament's Received Baptism Reconciliation Eucharist Confirmation Name of SchoolGrade EnteringPlease enter a number from 1 to 12.Date Date Format: MM slash DD slash YYYY CAPTCHA
