Member Registration Form "*" indicates required fields Family Last Name* Date MM slash DD slash YYYY Contact InformationAddress* Street Address Address Line 2 City ZIP Code Primary Phone*Family Email Cell Phone 1Cell Phone 1 belongs to: Cell Phone 2Cell Phone 2 belongs to: Family InformationMarital StatusSingleEngagedMarriedWidowedSepartedDivorcedPlease select one:Adult 1 First Name Last (if different from above) Nickname Maiden Name Choose one:MaleFemaleChoose one:Mr.Mrs.MissMs.OtherPlease enter your preferred title: Birthdate Email Occupation Employer Work PhoneReligion Please check each sacrament received: Baptism Confirmation Eucharist Reconciliation Select AllAdd another adult?NoYesAdult 2 First Name Last (if different from above) Nickname Maiden Name Choose one:MaleFemaleChoose one:Mr.Mrs.MissMs.OtherPlease enter your preferred title: Email Birthdate Occupation Employer Religion Work PhonePlease check each sacrament received: Baptism Confirmation Eucharist Reconciliation Select AllDo you have children?NoYesChildrenName First Middle Last (if different from family name) Please Select:MaleFemaleNickname Age Birthdate School Grade Email Religion Please select each sacrament received: Baptism Confirmation Eucharist Reconciliation Select AllAdd another child?NoYesName First Middle Last (if different from family name) Please Select:MaleFemaleNickname Age Birthdate School Grade Email Religion Please select each sacrament received: Baptism Confirmation Eucharist Reconciliation Select AllAdd another child?NoYesName First Middle Last (if different from family name) Please Select:MaleFemaleNickname Age Birthdate School Grade Email Religion Please select each sacrament received: Baptism Confirmation Eucharist Reconciliation Select AllAdd another child?NoYesName First Middle Last (if different from family name) Please Select:MaleFemaleNickname Age Birthdate School Grade Email Religion Please select each sacrament received: Baptism Confirmation Eucharist Reconciliation Select AllEmergency Contact InformationPlease include an emergency contact who is not included on this form.Name First Last Relationship PhoneOther InformationMay we put your name(s) in the parish bulletin as a welcome to new members?YesNoMay we include your photo on our New Member’s Bulletin Board?YesNoPlease include a household photo.Max. file size: 300 MB.Are you registered at another parish?NoYesWhat parish? Do you wish to continue that membership?NoYesWhat parish do you consider your primary? Would you like to receive envelopes?NoYesWould you like to know more about online giving?YesNoWould you like to receive email or text updates?YesNoCommunication Preference:EmailTextPlease select the types of communication you would like to receive: Weekly Updates Special Event Updates Elementary Middle School High School Adult Faith Formation Funeral Luncheons
