EmailMe Form - Family Registration form

EmailMeForm

FAMILY INFORMATION
Last Name *
Primary email for household *
Address *

Street Address City State / Province / Region Postal / Zip Code
What is your affiliation with the University of Georgia? *
First Language *
Please check the items you would like to receive
Donation envelopes
Georgia Bulletin
MEMBER INFORMATION
HEAD OF HOUSEHOLD (living in the household) *

Last Name

First Name

Maiden Name (enter 'n/a' if not applicable)
Title *
Dr.
Mr.
Mrs.
Ms.
Occupation *
Email *
Cell Phone *
### - ### - ####
Gender *
Male
Female
Date of Birth *
MM / DD / YYYY
Marital Status *
Single
Married
If married, indicate church of marriage:
Baptized? *
Yes
No
Catholic
Non-Catholic
Church of Baptism (include city)
Convert to Catholicism? *
Yes
No
If convert, Church of Catholic Baptism or Profession of Faith (include city)
Other Sacraments (check those received through the Catholic Church)

Received

First Communion

Confirmation
Volunteer Opportunities at the Catholic Center
Altar server
Eucharistic Minister
Lector/Reader
Choir/Music
Baking/Hospitality
Special Events
Other
Special Needs (Head of Household)
(Note any special requirements or accommodations that should be considered for the head of household)
SPOUSE (living in the household)

Last Name

First Name

Maiden Name (enter 'n/a' if not applicable)
Title
Dr.
Mr.
Mrs.
Ms.
Occupation
Email
Cell Phone
### - ### - ####
Gender
Male
Female
Date of Birth
MM / DD / YYYY
Marital Status
Single
Married
If married, indicate church of marriage:
Baptized?
Yes
No
Catholic
Non-Catholic
Church of Baptism (include city)
Convert to Catholicism?
Yes
No
If convert, Church of Catholic Baptism or Profession of Faith (include city)
Other Sacraments (check those received through the Catholic Church)

Received

First Communion

Confirmation
Volunteer Opportunities at the Catholic Center
Altar server
Eucharistic Minister
Lector/Reader
Choir/Music
Baking/Hospitality
Special Events
Other
Special Needs (Spouse)
(Note any special requirements or accommodations that should be considered for the spouse)
CHILD #1 (living in the household)
First Last
Gender
Male
Female
Date of Birth
MM / DD / YYYY
Baptized?
Yes
No
Catholic
Non-Catholic
Church of Baptism (include city)
Convert to Catholicism?
Yes
No
If convert, Church of Catholic Baptism or Profession of Faith (include city)
Other Sacraments (check those received through the Catholic Church)

Received

First Communion

Confirmation
Volunteer Opportunities at the Catholic Center
Altar server
Eucharistic Minister
Lector/Reader
Choir/Music
Baking/Hospitality
Special Events
Other
Special Needs (Child #1)
(Note any special requirements or accommodations that should be considered for Child #1)
CHILD #2 (living in the household)
First Last
Gender
Male
Female
Date of Birth
MM / DD / YYYY
Baptized?
Yes
No
Catholic
Non-Catholic
Church of Baptism (include city)
Convert to Catholicism?
Yes
No
If convert, Church of Catholic Baptism or Profession of Faith (include city)
Other Sacraments (check those received through the Catholic Church)

Received

First Communion

Confirmation
Volunteer Opportunities at the Catholic Center
Altar server
Eucharistic Minister
Lector/Reader
Choir/Music
Baking/Hospitality
Special Events
Other
Special Needs (Child #2)
(Note any special requirements or accommodations that should be considered for Child #2)
CHILD #3 (living in the household)
First Last
Gender
Male
Female
Date of Birth
MM / DD / YYYY
Baptized?
Yes
No
Catholic
Non-Catholic
Church of Baptism (include city)
Convert to Catholicism?
Yes
No
If convert, Church of Catholic Baptism or Profession of Faith (include city)
Other Sacraments (check those received through the Catholic Church)

Received

First Communion

Confirmation
Volunteer Opportunities at the Catholic Center
Altar server
Eucharistic Minister
Lector/Reader
Choir/Music
Baking/Hospitality
Special Events
Other
Special Needs (Child #3)
(Note any special requirements or accommodations that should be considered for Child #3)
CHILD #4 (living in the household)
First Last
Gender
Male
Female
Date of Birth
MM / DD / YYYY
Baptized?
Yes
No
Catholic
Non-Catholic
Church of Baptism (include city)
Convert to Catholicism?
Yes
No
If convert, Church of Catholic Baptism or Profession of Faith (include city)
Other Sacraments (check those received through the Catholic Church)

Received

First Communion

Confirmation
Volunteer Opportunities at the Catholic Center
Altar server
Eucharistic Minister
Lector/Reader
Choir/Music
Baking/Hospitality
Special Events
Other
Special Needs (Child #4)
(Note any special requirements or accommodations that should be considered for Child #4)

Last Name
First Name
Maiden Name (enter 'n/a' if not applicable)

	Received
First Communion
Confirmation

Last Name
First Name
Maiden Name (enter 'n/a' if not applicable)

	Received
First Communion
Confirmation

	Received
First Communion
Confirmation

	Received
First Communion
Confirmation

	Received
First Communion
Confirmation

	Received
First Communion
Confirmation

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FAMILY INFORMATION

MEMBER INFORMATION