Parishioner Registration Form

ABOUT US

• HISTORY • VISITORS • FINANCES • SCRIP • REGISTRATION

HEAD OF HOUSEHOLD

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Faith

Active

Inactive

SPOUSE

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Faith

Active

Inactive

MARITAL STATUS

Single

Married

Widow

Divorced

Anniversary Date

Wife's Maiden Name

CONTACT INFORMATION
Street Address	Apt. #
City	State	Zip Code
Home Phone	Work Phone	Email Address

CONTRIBUTIONS

Would you like to receive weekly contribution envelopes?

Yes

Would you like to be contacted about electronic giving?

Yes

CHILDREN IN HOME

CHILD 1

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 2

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 3

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 4

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 5

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 6

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 7

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

CHILD 8

Last Name

First Name

Middle Name

Name Goes By

Birthdate

Male

Female

OTHER QUESTIONS

Do you want to be announced in the Church Bulletin
as a new member?

Yes