Section 1: Household Information

Salutation as you'd like it printed on your envelope (required)

—Please choose an option—Mr.Mrs.Ms.Dr.Mr. & Mrs.Mrs. & Mr.

First Name as you'd like it printed on your envelope (required)

Last Name as you'd like it printed on your envelope (required)

Email (required)

Phone Number (required)

Street Address (required)

City (required)

State (required)

—Please choose an option—ALAKAZARCACOCTDEDCFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY

Zip Code (required)

Language(s) spoken at home (required)

EnglishSpanishKorean

Section 2: Marital Information

Current Marital Status (required)

—Please choose an option—MarriedSingleWidowed

Have you ever received an annulment through the Catholic Church? (required)

—Please choose an option—NoYes

Have you ever been divorced? (required)

—Please choose an option—NoYes

If married: Were you married in a Catholic church, in a civil service, or in another denominational church?

—Please choose an option—CatholicCivilOther denomination

Date of Marriage

Church/Place of Marriage

Adult 1

First Name (required)

Last Name (required)

Date of Birth (required)

Religion (required)

Which Sacraments have you received within the Catholic Church?(required)

BaptismFirst Holy CommunionConfirmation

Adult 2

First Name

Last Name

Date of Birth

Religion

Which Sacraments have you received within the Catholic Church?

BaptismFirst Holy CommunionConfirmation

Section 3: Children Information

If you have children in your household, please fill out the following section. Adult children need not be listed. If you do not have children in your household, skip ahead to Section 4.

Name(s)

Date(s) of Birth

Grade(s) / School(s) if Applicable

Is/are your child(ren) Baptized?

Did your child(ren) receive First Holy Communion?

Is/are your child(ren) Confirmed?

Section 4: Parish Involvement

Are you interested in receiving information on any of the following sacraments or sacramental preparation programs?

BaptismReligious Education Program (Grade 1-8)RCIA (age 14+)Marriage/Convalidation

Would you or anyone in your household be interested in any of these ministries in our parish?

Adult ChoirAltar Servers (Grade 2+)Bible StudyChildren's Choir (Grade 3+)Folk ChoirEnglish Conversation ClassEucharistic MinistersKnights of ColumbusLectorsLeisure Club (Seniors)Legion of MaryNetwork of CareNocturnal Adoration SocietyUshersYouth Group (Grade 7-12)

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