Blessed Teresa Parish Registration Form
Please add as much information as possible.
Fields with asterisk are mandatory.
Date
*
MM
/
DD
/
YYYY
Name
*
Prefix
First
*
Last
*
Suffix
Address
*
Street Address
*
Address Line 2
City
*
State / Province / Region
*
Postal / Zip Code
*
Country
*
Phone Number
*
###
-
###
-
####
Email
Marriage Information
Please Select One
Married
Divorced
Widow/Widower
Date of Marriage
Name of Church
Valid Catholic Marriage?
Yes
No
Would anyone in your family like to speak with a Priest?
Yes
Phone
Email
To select more than one, hold the control key down while selecting.
Individual Member and Sacramental Information
Name #1
Prefix
First
Last
Suffix
Maiden Name
Role in Family
Head of House
Husband
Wife
Gender
Male
Female
Date of Birth mm/dd/yyyy
Parish Status
Active
Inactive
Baptized
Yes
No
Catholic
To select more than one, hold the control key down while selecting.
Date of Baptism
(if known or parish)
Date of 1st Reconciliation
(if known or parish)
Date of 1st Eucharist
if known or parish
Date of Confirmation
(if known or parish)
Occupation/Employer
First Language
Name #2
Prefix
First
Last
Suffix
Maiden Name
Role in Family
Head of House
Husband
Wife
Gender
Male
Female
Date of Birth mm/dd/yyyy
Parish Status
Active
Inactive
Baptized
Yes
No
Catholic
To select more than one, hold the control key down while selecting.
Date of Baptism
(if known or parish)
Date of 1st Reconciliation
(if known or parish)
Date of 1st Eucharist
if known or parish
Date of Confirmation
(if known or parish)
Phone Number Work/Cell
###
-
###
-
####
First Language
Dependent Children Information
Please fill in all applicable information
Child #1
Prefix
First
Last
Suffix
Gender
Male
Female
Date of Birth mm/dd/yyyy
Grade/Middle/High School
(Graduation year?)
Baptized
Yes
No
Catholic
To select more than one, hold the control key down while selecting.
Date of Baptism
(if known or parish)
Date of 1st Reconciliation
(if known or parish)
Date of 1st Eucharist
if known or parish
Date of Confirmation
(if known or parish)
Child #2
Prefix
First
Last
Suffix
Gender
Male
Female
Date of Birth mm/dd/yyyy
Grade/Middlel/High School
(Graduation year?)
Baptized
Yes
No
Catholic
To select more than one, hold the control key down while selecting.
Date of Baptism
(if known or parish)
Date of 1st Reconciliation
(if known or parish)
Date of 1st Eucharist
if known or parish
Date of Confirmation
(if known or parish)
Child #3
Gender
Male
Female
Date of Birth mm/dd/yyyy
Grade/Middle/High School
(Graduation year?)
Baptized
Yes
No
Catholic
To select more than one, hold the control key down while selecting.
Date of Baptism
(if known or parish)
Date of 1st Reconciliation
(if known or parish)
Date of 1st Eucharist
if known or parish
Date of Confirmation
(if known or parish)
Child #4
Prefix
First
Last
Suffix
Date of Baptism
(if known or parish)
Gender
Male
Female
Date of Birth mm/dd/yyyy
Grade/Middlle/High School
(Graduation year?)
Baptized
Yes
No
Catholic
To select more than one, hold the control key down while selecting.
Date of Baptism
(if known or parish)
Date of 1st Reconciliation
(if known or parish)
Date of 1st Eucharist
if known or parish
Date of Confirmation
(if known or parish)
If more children, please add info here.
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