EmailMe Form - Parish Registration

Family Name *

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Home Phone

### - ### - ####

Email

Parish Contributions *

Please Contact me about the online donation program

We would like to use envelopes

Unless you are using the Credit Card Donation Program, you will receive starter envelopes in the mail in 2 to 3 weeks and regular envelopes in the mail every other month.

Individual Members of the family

Adult in the Household *

First Last

Date Of Birth

MM / DD / YYYY

Cell Phone

### - ### - ####

Baptized Catholic

Baptized Other

Other Sacraments Needed:

Parish Ministeries

Adult in the Household

First Last

Date Of Birth

MM / DD / YYYY

Cell Phone

### - ### - ####

Multiple Choice

Baptized Catholic

Baptized Other

Other Sacraments Needed:

Parish Ministeries

Marital Status

Was your marriage ever witnessed by a priest?

Yes

No

If no, would you like to be contacted about having your marriage witnessed by a priest?

Yes

No

____________________________________

Child in the household

First Last

Date Of Birth

MM / DD / YYYY

Boy

Girl

Baptized Catholic

Baptized Other

Other Sacraments Needed:

Child in the household

First Last

Date Of Birth

MM / DD / YYYY

Boy

Girl

Baptized Catholic

Baptized Other

Other Sacraments Needed:

Child in the household

First Last

Date Of Birth

MM / DD / YYYY

Boy

Girl

Baptized Catholic

Baptized Other

Other Sacraments Needed: