CAPTCHAToday's date: Date Format: MM slash DD slash YYYY Family InformationFamily Surname:*Address:*City:*State:*Zip:*Primary Phone:*Cell Phone:Primary Email Address:* Secondary Email Address:Member InformationFirst Name:*MI:Last Name:*Birthdate:*Maiden Name:Gender:* Male Female Religious Denomination:*Baptismal Status:* Catholic Convert Protestant Not Baptized Eucharist:* Yes No Confirmed Catholic:* Yes No Marriage Status:* Single Catholic Marriage Other Marriage Widowed Divorced Email: Occupation:SpouseFirst Name:MI:Last Name:Birthdate:Maiden Name:Gender: Male Female Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Occupation:Additional Family MembersAdd a family member? Yes Family Member Information:First Name:*MI:Last Name (if different):*Birthdate:* Date Format: MM slash DD slash YYYY Gender:* Male Female Relationship to you/Head of Family:*Religious Denomination:*Baptismal Status:* Catholic Convert Protestant Not Baptized Eucharist:* Yes No Confirmed Catholic:* Yes No Marriage Status:* Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:*MI:Last Name (if different):*Birthdate:* Date Format: MM slash DD slash YYYY Gender:* Male Female Relationship to you/Head of Family:*Religious Denomination:*Baptismal Status:* Catholic Convert Protestant Not Baptized Eucharist:* Yes No Confirmed Catholic:* Yes No Marriage Status:* Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Add another family member: Yes Family Member Information:First Name:MI:Last Name (if different):Birthdate: Date Format: MM slash DD slash YYYY Gender: Male Female Relationship to you/Head of Family:Religious Denomination:Baptismal Status: Catholic Convert Protestant Not Baptized Eucharist: Yes No Confirmed Catholic: Yes No Marriage Status: Single Catholic Marriage Other Marriage Widowed Divorced Email Address:Ministries / Groups / TalentsPlease check areas of interestLiturgy & Music E.M.H.C. Lector Usher Altar Server Choir / Cantor Prayer Groups Legion of Mary Divine Mercy Cenacle Mother of Joy / Charismatic Blue Army Religious Education & Youth K - 12 Catechist + Aide Adult Faith Formation Youth Ministry Scouting Various Groups Service / Outreach Knights of Columbus Men's Group Mom's Group Silver Foxes (55 & over) Seton Crafters Running Club Softball Team Respect Life Hospitality Arbor Committee Office Volunteer Other (list below) Other:Would you like a copy of your parish registration form?*Yes, send it to my primary email.No.PhoneThis field is for validation purposes and should be left unchanged.
