• Household Registration

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  • Today's Date REQUIRED Please fill out this field. Please enter a date.
  • Family Name (for mailings) REQUIRED Please fill out this field. Please enter valid data.
  • Your First Name REQUIRED Please fill out this field. Please enter valid data.
  • Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Street Address REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Primary Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • Head of Household 1
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Nickname Please enter valid data.
  • Maiden Name (if applicable) Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter a date.
  • Gender REQUIRED (Select One) Male Female Please fill out this field.
  • Religion REQUIRED Please fill out this field. Please enter valid data.
  • Sacraments REQUIRED Baptism Reconciliation First Communion Confirmation Matrimony Please fill out this field.
  • Marital Status (select one) REQUIRED (Select One) Single Married in the Catholic Church Civil Marriage Divorced Separated Widowed Please fill out this field.
  • Date of Marriage (if applicable) Please enter a date.
  • Occupation: Please enter valid data.
  • Special Needs?
  • Head of Household 2
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Nickname Please enter valid data.
  • Maiden Name (if applicable) Please enter valid data.
  • Date of Birth Please enter a date.
  • Gender None Male Female
  • Religion REQUIRED Please fill out this field. Please enter valid data.
  • Sacraments REQUIRED Baptism Reconciliation First Communion Confirmation Matrimony Please fill out this field.
  • Occupation: Please enter valid data.
  • Special Needs?
  • Would you like to be added to our email list (parish updates, news and events)? REQUIRED Yes No Please fill out this field.
  • About Your Children (#1)
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Middle Name Please enter valid data.
  • Date of Birth Please enter a date.
  • Gender None Male Female
  • Religion Please enter valid data.
  • Sacraments (Please check all sacraments that this child has received) Baptism Reconciliation First Communion Confirmation
  • About Your Children (#2)
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Middle Name Please enter valid data.
  • Date of Birth Please enter a date.
  • Gender None Male Female
  • Religion Please enter valid data.
  • Sacraments (Please check all sacraments that this child has received) Baptism Reconciliation First Communion Confirmation Matrimony
  • About Your Children (#3)
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Middle Name Please enter valid data.
  • Date of Birth Please enter a date.
  • Gender None Male Female
  • Religion Please enter valid data.
  • Sacraments (Please check all sacraments that this child has received) Baptism Reconciliation First Communion Confirmation Matrimony
  • About Your Children (#4)
  • First Name Please enter valid data.

    Last Name Please enter valid data.
  • Middle Name Please enter valid data.
  • Date of Birth Please enter a date.
  • Gender None Male Female
  • Religion Please enter valid data.
  • Sacraments (Please check all sacraments that this child has received) Baptism Reconciliation First Communion Confirmation
  • Please choose a giving option: REQUIRED I would like to donate electronically. See our website for Faith Direct and Online Giving options. I prefer to receive Offertory Envelopes in the mail. Please fill out this field.

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