| Household Name (family name) * | | |
| Head of Household - Last name, First name * | | |
| Head of Household -Birth Date * | |
|
| Street Address -- City, State, ZIP * | | |
| Alternate address -- used seasonally |  | |
| Phone Number * | | |
| Cell Phone | | |
| email address | | |
| Head of Household -Religion * | | |
| Occupation of Head of Household | | |
| Head of Household Work Phone number | | |
| Head of Household -Baptized * | | |
| Head of Household -Baptism date | |
|
| Head of Household -Confirmed * | | |
| Head of Household - Date of Confirmation (if Confirmed) | |
|
| Are you transferring from another Parish? * | | |
| If you are transferring from another Parish please list the name and city | | |
| Parish Commitment | | |
| Gifts of Time and Talent I would like to offer. | | |
| Would you like weekly offering envelopes? | | |
| Would like automatic withdrawal? | | |
| Relationship Status * | | |
| If married, your wedding Date? | |
|
| Spouse - Last name, First name | | |
| Spouse - Birth Date | |
|
| Spouse - email | | |
| Spouse - Religion | | |
| Spouse -Baptized | | |
| Spouse- Baptism Date | |
|
| Spouse -Confirmed | | |
| Date of Confirmation (if Confirmed) | |
|
| Occupation of Spouse | | |
| Gifts of Time and Talent I (spouse) would like to offer. | | |
| 1st Child - Last name, First name | | |
| 1st Child- Birth Date | |
|
| 1st Child -Baptized | | |
| 1st Child - Baptisim Date | |
|
| 1st Child -Confirmed | | |
| Date of Confirmation (if Confirmed) | |
|
| 2nd Child - Last name, First name | | |
| 2nd Child- Birth Date | |
|
| 2nd Child -Baptized | | |
| 2nd Child - Baptisim Date | |
|
| 2nd Child -Confirmed | | |
| Date of Confirmation (if Confirmed) | |
|
| 3rd Child - Last name, First name | | |
| 3rd Child- Birth Date | |
|
| 3rd Child -Baptized | | |
| 3rd Child - Baptisim Date | |
|
| 3rd Child -Confirmed | | |
| 4th Child - Last name, First name | | |
| Date of Confirmation (if Confirmed) | |
|
| 4th Child -Baptized | | |
| 4th Child- Birth Date | |
|
| 4th Child - Baptisim Date | |
|
| 4th Child -Confirmed | | |
| Date of Confirmation (if Confirmed) | |
|
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