DATE OF REGISTRATION   _________________ 

Env. #_________

Marital Status:

_____Single     

_____Married      

_____Separated/Divorced/Widowed   

Would you like weekly collection envelopes sent to you?

Yes / No

Husband’s Information

Full Name:

_______________________________________

Catholic? 

Yes / No

Preferred Name

(if different)

_______________________________________

Date of Birth

___/____/____

Sacraments:

(circle all that

apply)

Baptism

Marriage

1^st Holy Communion

Confirmation

Wife’s Information

Full Name:

___________________________________________

Catholic? 

Yes / No

Birth Name:

(if different)

___________________________________________

Preferred Name

(if different)

___________________________________________

Date of Birth

___/____/____

Sacraments:

(circle all that apply)

Baptism

Marriage

1^st Holy Communion

Confirmation

Children’s Information

Full names of children:

Date of :

school/ grade

Sacraments

B

M

C

C

1.

___________________________

___/____/____

__

___

___

___

2.

___________________________

___/____/____

___

___

___

___

3.

___________________________

___/____/____

___

___

___

___

4.

___________________________

___/____/____

___

___

___

___

Contact Information

Street/ Mailing Address

__________________________________________

Zip Code

___________

PO Box

___________

Home Phone

_________________

(Unlisted)

Yes / No

History

Church of Marriage

_________________________________________________

Date of  Marriage

_________________________________________________

Former Parish

_________________________________________________

Other Information

Church groups you would like to have more information about:

Finance Council

Pastoral Council

Adult Education

CCD

Barton’s Crossing

Food Kitchen

Coffee Hour Volunteer

Volunteer

Lectors Eucharistic Ministry

Alter Server

Holiday Caroling

Church Choir

Ushers

Welcoming Committee 

Other.: ________________________________