Parish Registration Step 1 of 4 25% CAPTCHAProfile of HouseholdEnvelope NumberFamily Name(Required) Home Phone Number(Required)Listed?(Required) Yes No Address(Required) 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 Ethnic Background(Required) African America Asian Caucasian Hispanic Other Please explain other(Required) Language Spoken at Home(Required) Other Dependents living at Home(Required) Yes No List Other Dependents and Non-Relatives Living in the Home(Required)Name (First, Middle, Last)RelationshipDate of Birth Add RemovePlease click the plus button the right side to add additional peopleSingle Parent Household?(Required) Yes No All Children Baptized?(Required) Yes No N/A Household Needs Pastoral Visit?(Required) Yes No Family Involved in Religious Education?(Required) Yes No Family Involved in Catholic Schools?(Required) Yes No CommentsHead of HouseholdName(Required) First Middle Last Nickname Email(Required) Phone(Required)Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Your Religion(Required) Active(Required) Yes No Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation Profession of Faith RCIA Traditional None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Marital Status(Required) Single Married Civilly Married Sacramentally Divorced Widowed Date & Church (City/ST) of Marriage(Required) Marriage Declared null?(Required) Yes No Validation of Current Marriage?(Required) Yes No Employer(Required) Occupation(Required) Other Skills Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Attended Catholic Schools(Required) Yes No Highest Degree(Required)High SchoolAssociate DegreeBachelor's DegreeGraduate or Professional DegreeSome CollegeOtherPrefer Not to AnswerNumber of Children living at home(Required) Spouse InformationName(Required) First Middle Last Nickname Email(Required) Phone(Required)Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Your Religion(Required) Active(Required) Yes No Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation Profession of Faith RCIA Traditional None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Employer(Required) Occupation(Required) Other Skills Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Attended Catholic Schools(Required) Yes No Highest Degree(Required)High SchoolAssociate DegreeBachelor's DegreeGraduate or Professional DegreeSome CollegeOtherPrefer Not to Answer Child 1 InformationName(Required) First Middle Last Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Year of First Reconciliation(Required)School Attending(Required) Grade(Required) Relationship in Household(Required) Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Religious Education(Required) Yes No Child 2 InformationName(Required) First Middle Last Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Year of First Reconciliation(Required)School Attending(Required) Grade(Required) Relationship in Household(Required) Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Religious Education(Required) Yes No Child 3 InformationName(Required) First Middle Last Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Year of First Reconciliation(Required)School Attending(Required) Grade(Required) Relationship in Household(Required) Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Religious Education(Required) Yes No Child 4 InformationName(Required) First Middle Last Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Year of First Reconciliation(Required)School Attending(Required) Grade(Required) Relationship in Household(Required) Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Religious Education(Required) Yes No Child 5 InformationName(Required) First Middle Last Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Year of First Reconciliation(Required)School Attending(Required) Grade(Required) Relationship in Household(Required) Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Religious Education(Required) Yes No Child 6 InformationName(Required) First Middle Last Sex(Required) Male Female Date of Birth(Required) Month Day Year City/ST of Birth(Required) Father's Name(Required) First Last Mother's Name(Required) First Last Maiden Faith Journey(Required)Select all that you have received or done Baptism Eucharist Reconciliation Confirmation None Date of Baptism(Required) Month Day Year Church & Location of Church of Baptism(Required) Year of First Reconciliation(Required)School Attending(Required) Grade(Required) Relationship in Household(Required) Do you need special assistance?(Required) Disabled Homebound Special Needs None of the above Religious Education(Required) Yes No Additional InformationFamily would like to share their time and talent in the following areasPlease click the plus button on the right side to add additional names and areasNameArea(s) Add RemoveReason for RegisteringNotesNameThis field is for validation purposes and should be left unchanged.
