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 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?* 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 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* 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 PhoneAdd 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 Entering*Please 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
