Parish Registration and/or Information Update Page * below denotes required fields * Reason for completing this form: New Registration Update my information Preferred Salutation Mr. & Mrs.; Ms.; Miss; Dr. & Mrs.; John & Judy; etc. Last Name Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP Code * Home Phone * Head of Household (HOH) First Last * Family Status Single (residing alone) Single (residing with parents) Married with Minor Children Married without Minor Children Single Parent with minor children Divorced (residing alone) Divorced with minor children Living with "significant other" Widow(er) (residing alone) Widow(er) with minor children Widow(er) (residing with adult children) Other (Identify below) Would you provide us with the name & number of a next-of-kin? As you appear to be living alone, past experience has show it's helpful to have a person to contact - should you fall ill, or some other emergency arise. Family Status Other (if "Other" from above) * Date of Birth (HOH) Religion (HOH) * Occupation (HOH) If student, list institution & anticipated graduation date Employer (HOH) Cell Phone (HOH) Work Phone (HOH) E-Mail Address (HOH) Email Confirm Email Sacramental History (HOH) * Baptized? (HOH) Yes No * First Eucharist? (HOH) Yes No * Confirmed? (HOH) Yes No * Are you married? Yes No First or Second Marriage First Marriage Second Marriage Three-or-more Marriages Marriage Date Were you married by a priest? Yes No Church or place of marriage Street Address Address Line 2 City Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming State ZIP Code Please enter whatever info you have readily available * Do you have children? Yes No How many children do you have? 1 2 3 4 5 6 Spouse Your spouse's information Spouse's Name First Last Date of Birth (Spouse) Religion (Spouse) Occupation (Spouse) if student, list institution & anticipated graduation date Work Phone (Spouse) E-Mail (Spouse) Email Confirm Email Cell Phone (Spouse) Sacramental History Baptized? (Spouse) Yes No First Eucharist? (Spouse) Yes No Confirmed? (Spouse) Yes No Is this your ... First Marriage Second Marriage Three-or-more Marriages Maiden Name First Child Please fill in all information for each child Adult children who reside at home (typically those older than 25, as well as those who are out of school and gainfully employed) must submit their own parish registration form. First Child's Name First Last Date of Birth (Child 1) Gender assigned at birth (Child 1) Male Female Baptized? (Child 1) Yes No First Communion? (Child 1) Yes No Confirmed? (Child 1) Yes No Religious Education (Child 1) PSR Catholic School None Present School (Child 1) Second Child Please fill in all information for each child Second Child's Name First Last Date of Birth (Child 2) Gender assigned at birth (Child 2) Male Female Baptized? (Child 2) Yes No First Communion? (Child 2) Yes No Confirmed? (Child 2) Yes No Religious Ed (Child 2) PSR Catholic School None Present School (Child 2) Third Child Please fill in all information for each child Third Child's Name First Last Date of Birth (Child 3) Gender assigned at birth? (Child 3) Male Female Baptized? (Child 3) Yes No First Communion? (Child 3) Yes No Confirmed? (Child 3) Yes No Religious Education PSR Catholic School None Present School Fourth Child Please fill in all information for each child Fourth Child's Name First Last Date of Birth (Child 4) Gender assigned at birth (Child 4) Male Female Baptized? (Child 4) Yes No First Communion? (Child 4) Yes No Confirmed? (Child 4) Yes No Religious Education (Child 4) PSR Catholic School None Present School (Child 4) Fifth Child Please fill in all information for each child Fifth Child's Name First Last Date of Birth (Child 5) Gender assigned at birth (Child 5) Male Female Baptized? (Child 5) Yes No First Communion? (Child 5) Yes No Confirmation? (Child 5) Yes No Religious Education (Child 5) PSR Catholic School None Present School (Child 5) Sixth Child Please fill in all information for each child Sixth Child's Name First Last Date of Birth (Child 6) Gender assigned at birth (Child 6) Male Female Baptized? (Child 6) Yes No Eucharist? (Child 6) Yes No Confirmed? (Child 6) Yes No Religious Education (Child 6) PSR Catholic School None Present school (Child 6) Two final questions before you finish: * May we identify you in the bulletin as a new parishioner? Yes No Does anyone at this address require Sacramental services at home? * Secure