EmailMe Form - 2016-2017 RCIA Registration Form

EmailMeForm

Name *
First Middle Last
Address *

Street Address City State / Province / Region Postal / Zip Code
Email *
Phone Number *
### - ### - ####
Profession *
Baptism
Attach a copy of your baptismal certificate
Date Baptized
MM / DD / YYYY
Name of Church
City, State & Zip Code
Parents
Father's Name
First Last
Mother's Name

First

Maiden

Last
Birth Information
Birthdate
MM / DD / YYYY
Birthplace (City & State)
Marital Status Information
Status (check one)
Married
Single, never married
Separated
Divorced
Widowed
Husband/Wife's Name
First Last
Spouse's Religion
Marriage Date
MM / DD / YYYY
Married by
Priest
Minister
Justice of the Peace
If in a Church, name of the Church
City & State
Have you been married before?
Yes
No
If married previously, how many times?
Have these previous marriages been annulled by the Catholic Church?
Yes
No
Not applicable
Or ended in death?
Yes
No
Not applicable
Number of annulments
Number of divorces
Has your present husband/wife been married before?
Yes
No
Not applicable
If yes, how many times?
Have his/her marriages been annulled?
Yes
No
Not applicable
Or ended in death?
Yes
No
Not applicable
Please list the names and ages of any children you have living at home
Sacraments
(Check the sacraments you want to receive)
Sacraments desired
Baptism
Confirmation
Eucharist
Reconciliation
Sponsor
(Must be Confirmed and a practicing Catholic)
Sponsor Name
First Last
Is sponsor a member of the Catholic Center?
Yes
No
Previous Church Affiliation
When was the last year you were active in the church?
What denomination?
Besides the church you just named, have you had affiliation with any other churches?
Yes
No
Please list the name(s) of church and city /state

First
Maiden
Last

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Baptism

Parents

Birth Information

Marital Status Information

Sacraments

Sponsor

Previous Church Affiliation