New Member Registration New Member Registration Form 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: Select All Baptism Confirmation Eucharist Reconciliation Add 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: Select All Baptism Confirmation Eucharist Reconciliation Do 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: Select All Baptism Confirmation Eucharist Reconciliation Add 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: Select All Baptism Confirmation Eucharist Reconciliation Add 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: Select All Baptism Confirmation Eucharist Reconciliation Add 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: Select All Baptism Confirmation Eucharist Reconciliation Emergency Contact InformationPlease include an emergency contact who is not included on this form.Name First Last Relationship PhoneOther InformationMay we welcome you in our parish bulletin?YesNoMay we include your photo on our New Member’s Board?YesNoPlease include a household photo.Max. file size: 100 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?YesNoCAPTCHA