Parish Registration Form

Office use only

PDS

Reported to Archindy

# ID

If when answering questions, you do not have an applicable answer, please just put NA.

Head of Household Name (the way you want it addressed in correspondence)(Required)

Prefix First Middle Last

Date of Birth(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email(Required)

Spouses Name if applicable

Prefix First Middle Last

Birth Date if applicable

Spouses Phone if applicable, otherwise put NA

Spouse's Email

Children/dependent Information: Please include the following information for each child or dependent in your household. First, Middle, Last name, Sex, Birth Date, School/College and Grade year.(Required)

Sacramental Information Religion/Denomination for all who live in the household.Please list the person's name, religion, date of baptism. Location of Baptism, church, city, and state(Required)

First Communion: Please list the date and location of each person who has received their First Communion

Confirmations: Please list the date and location of each person who has received their Confirmation.

Sacrament of Marriage (if applicable)

Date and location

Please indicate if you will be an envelope user or online giving(Required)

I am interested in the following ministries

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