Family Last Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern 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CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Primary Contact Phone*Primary Contact Phone Type* Home Cell Work Primary Contact Email* Enter Email Confirm Email Residency* Year Round Seasonal Type of Household* Adult and spouse Adults and children Adults only 1 Adult Single Parent Other Enter number of additional adults to register*Please enter a number from 1 to 3.Enter number of children to register*Please enter a number from 1 to 6.Head of Household Name* First Last Prefix*Mr.Mrs.Ms.MissDr.Date of Birth* MM slash DD slash YYYY mm/dd/yyyyReligion*Sacraments Received* Baptism First Communion Confirmation None Occupation*Is your phone number the same as the Primary Contact phone number entered above?* Yes No Enter your phone number*Enter your phone type* Home Cell Work Is your Email the same as the Primary Contact Email entered above?* Yes No Enter your Email* Enter Email Confirm Email Marital Status* Single Catholic Marriage Other Marriage Widowed Divorced Maiden NameSpouse Name* First Last Spouse Prefix*Mr.Mrs.Ms.Spouse Maiden NameSpouse Date of Birth* MM slash DD slash YYYY mm/dd/yyyySpouse Religion*Sacraments Received* Baptism First Communion Confirmation None Spouse Occupation*Is your phone number the same as the Primary Contact phone number entered at the top of this form?* Yes No Enter your phone number*Enter your phone type* Home Cell Work Is your Email the same as the Primary Contact Email entered at the top of this form?* Yes No Enter your Email* Enter Email Confirm Email Children InformationChild 1 Name* First Last Child 1 Gender* Female Male Child 1 Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Does this child attend school?* Yes No Child 1 Grade* Pre-K to Gr 8 Gr 9 to 12 Post High School Child 1 School*Child 2 Name* First Last Child 2 Gender* Female Male Child 2 Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Does this child attend school?* Yes No Child 2 Grade* Pre-K to Gr 8 Gr 9 to 12 Post High School Child 2 School*Child 3 Name* First Last Child 3 Gender* Female Male Child 3 Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Does this child attend school?* Yes No Child 3 Grade* Pre-K to Gr 8 Gr 9 to 12 Post High School Child 3 School*Child 4 Name* First Last Child 4 Gender* Female Male Child 4 Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Does this child attend school?* Yes No Child 4 Grade* Pre-K to Gr 8 Gr 9 to 12 Post High School Child 4 School*Child 5 Name* First Last Child 5 Gender* Female Male Child 5 Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Does this child attend school?* Yes No Child 5 Grade* Pre-K to Gr 8 Gr 9 to 12 Post High School Child 5 School*Child 6 Name* First Last Child 6 Gender* Female Male Child 6 Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Does this child attend school?* Yes No Child 6 Grade* Pre-K to Gr 8 Gr 9 to 12 Post High School Child 6 School*Member InformationFirst Additional Adult – Name* First Last Gender* Female Male Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Occupation*Phone Number*Enter your phone type* Home Cell Work Email* Enter Email Confirm Email Relationship to Head of Household* Daughter Son Parent Other Second Additional Adult – Name* First Last Gender* Female Male Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Occupation*Phone Number*Enter your phone type* Home Cell Work Email* Enter Email Confirm Email Relationship to Head of Household* Daughter Son Parent Other Third Additional Adult – Name* First Last Gender* Female Male Birth Date* MM slash DD slash YYYY mm/dd/yyyySacraments Received* Baptism First Communion Confirmation None Occupation*Phone Number*Enter your phone type* Home Cell Work Email* Enter Email Confirm Email Relationship to Head of Household* Daughter Son Parent Other Ministries / Groups / TalentsPlease check areas you or any of the other persons registered in your family are interested in.Weekend Liturgy E. M. H. C. Altar Server Sacristan Host Minister Greeter Technology Team Info Booth Holy Grounds Cafe Music Ministry Faith Formation Small Groups Rite of Christian Initiation of Adults (RCIA) Bible Study School of Christian Formation Catechist – Children’s Religious Education Children’s Liturgy of the Word Volunteer Organizations Ascension Council of Catholic Women (ACCW) Men’s Club Knights of Columbus Missions Respect Life Youth Ministry Emergency Contact InformationEmergency Contact Name*Relationship* Spouse Parent Son Daughter Friend Other Phone*CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.
