Family Name Date
Address City State Zip
Phone Your Family Email
May we publish contact information in parish directories and parish Guide Book? (Please select yes or no.) ---YesNo
Adult #1: Full Name Date of Birth (DOB)
Ethnicity Maiden Name
Please check which sacraments Adult #1 has received.
Catholic BaptismNon-Catholic BaptismReconciliationCommunionConfirmation
Adult #2: Full Name Date of Birth (DOB)
Please check which sacraments Adult #2 has received.
Please check the following. *"Other Marriage" includes those from other faith denominations or civil ceremonies.
Marital Status: SingleCatholic Marriage*Other MarriageSeparatedDivorcedWidowed
Marriage Date Church City, State
List dependent children only. In our diocese, Catholics are expected to register with a parish in order to be eligible for sacraments such as marriage, baptism, etc. Adult, non-dependent children should be registered separately to establish eligibility for services. If an adult, non-dependent child attends Holy Family, ask him/her to register as a parishioner.
Child's Name Birthdate MaleFemale
Catholic BaptismNon-Catholic BaptismCommunionConfirmation