Registration for new parishioners and census for existing parishioners

Family Name: (required)

Maiden Name:

Street Address: (required)

Apartment Number:

City: (required)

State: (required)

Zip Code: (required)

Site usually attending mass: (required)

Phone: (required)

Is the phone unlisted: (required)

Email: (required)

Married by priest / deacon? (required)

Date married (*):

Mailing Address (if different from street address):


Adult #1

Adult #1 Title: (required)

Adult #1 Full Name: (required)

Adult #1 Date of Birth: (required)

Adult #1 Sex: (required)

Adult #1 Marital Status: (required)

Adult #1 Special Needs: (required)

Adult #1 Special Needs (other):

Adult #1 Work Status: (required)

Adult #1 occupation:

Adult #1 work phone: (required)

Adult #1 Baptized: (required)

Adult #1 Penance: (required)

Adult #1 Eucharist: (required)

Adult #1 Confirmed: (required)

Adult #1 Attend Mass: (required)

Adult #1 - How can your parish assist you?

Adult #1 - How can your parish assist you (other)?


Adult #2

Adult #2 Title:

Adult #2 Full Name:

Adult #2 Date of Birth:

Adult #2 Sex:

Adult #2 Marital Status:

Adult #2 Special Needs:

Adult #2 Special Needs (other):

Adult #2 Work Status:

Adult #2 occupation:

Adult #2 work phone:

Adult #2 Baptized:

Adult #2 Penance:

Adult #2 Eucharist:

Adult #2 Confirmed:

Adult #2 Attend Mass:

Adult #2 - How can your parish assist you?

Adult #2 - How can your parish assist you (other)?


Child #1

Child #1 Full Name:

Child #1 Date of Birth:

Child #1 Sex:

Child #1 Special Needs: (required)

Child #1 Special Needs (other):

Child #1 Grade Level:

Child #1 Baptized:

Child #1 Penance:

Child #1 Eucharist:

Child #1 Confirmed:

Child #1 Attend Mass:

Child #1 - How can your parish assist you?

Child #1 - How can your parish assist you (other)?


Child #2

Child #2 Full Name:

Child #2 Date of Birth:

Child #2 Sex:

Child #2 Special Needs: (required)

Child #2 Special Needs (other):

Child #2 Grade Level:

Child #2 Baptized:

Child #2 Penance:

Child #2 Eucharist:

Child #2 Confirmed:

Child #2 Attend Mass:

Child #2 - How can your parish assist you?

Child #2 - How can your parish assist you (other)?


Child #3

Child #3 Full Name:

Child #3 Date of Birth:

Child #3 Sex:

Child #3 Special Needs: (required)

Child #3 Special Needs (other):

Child #3 Grade Level:

Child #3 Baptized:

Child #3 Penance:

Child #3 Eucharist:

Child #3 Confirmed:

Child #3 Attend Mass:

Child #3 - How can your parish assist you?

Child #3 - How can your parish assist you (other)?


Child #4

Child #4 Full Name:

Child #4 Date of Birth:

Child #4 Sex:

Child #4 Special Needs: (required)

Child #4 Special Needs (other):

Child #4 Grade Level:

Child #4 Baptized:

Child #4 Penance:

Child #4 Eucharist:

Child #4 Confirmed:

Child #4 Attend Mass:

Child #4 - How can your parish assist you?

Child #4 - How can your parish assist you (other)?

NOTE: If you have more children, please fill out another form (or more) and send them.

You need only fill out 1 adult if it is the second or more form.

Additional Comments?




(*) Depending on your browser, the date can be accepted in many ways. Below are a few examples.

Microsoft Internet Explorer: (YYYY-MM-DD)
2016-01-05

Microsoft Edge with Windows 10: (has the ability to click and select a date, but uses MM-DD-YYYY)

Google Chrome: (has the ability to click and select a date, but uses MM-DD-YYYY)

If problems persist, please email the webmaster (email at the bottom of this page) with the browser you are using.