Parish Registration

Head of Household Information

First Name:	Last Name:	Middle Initial:
Religion:	Date of Birth:	Gender: Male Female
Baptized? Yes No	1st Communion? Yes No	Reconciliation? Yes No	Confirmation? Yes No
Marital Status: Single    Married    Widowed   Divorced		Occupation:
Marriage Date:	Catholic Church/City:	Other Ceremony:

Spouse Information

First Name:	Last Name:	Middle Initial:	Maiden (Name):
Religion:	Date of Birth:	Gender: Male Female
Baptized? Yes No	1st Communion? Yes No	Reconciliation? Yes No	Confirmation? Yes No
Marital Status: Single    Married    Widowed   Divorced		Occupation:

Address Information
Address:
City:	State: Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming	Zip:
Primary Phone:	Secondary Phone:
Email: Send E-Mail instead of mail when possible? Yes No

Children at Home

Full Name (First, Middle, Last) Catholic M/F Birth Date Grade/School Baptism Eucharist Confirmation Yes No M F Yes No Yes No Yes No Yes No M F Yes No Yes No Yes No Yes No M F Yes No Yes No Yes No Yes No M F Yes No Yes No Yes No Yes No M F Yes No Yes No Yes No Yes No M F Yes No Yes No Yes No

Do you wish to receive the Diocesan newspaper, The Catholic Herald?: Yes No

Do we have permission to publish your family name and individual members in our publications?: Yes No

Do you have any specific talents/skills that you would like to make the parish staff aware of? Would you be willing to share your talents/skills if the Parish may need you? Please describe:

List family members who are Sacred Hearts School Alumni:

Please list any disabilities of any family members that we should be aware of:

Please tell us if any family members are shut-in:

Please list languages (other than English) spoken by family members: