Parish Registration

Today's Date REQUIRED Please fill out this field. Please enter a date.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Spouse Name (Include Last Name if different from family name) Please enter valid data.

Spouse's Date of Birth Please enter a date.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Mailing Address (if different from above) Please enter valid data.

Mail Preference REQUIRED Please fill out this field.

Relatives in Parish? Yes No

Name (if yes) Please enter valid data.

Home Phone Number Please enter a phone number.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Spouse's Cell Phone Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Spouse's Email Please enter an email address.

Marital Status REQUIRED Please fill out this field.

Maiden Name (if applicable) Please enter valid data.

Date of Marriage Please enter a date.

Church Name and Location of Marriage Please enter valid data.

Marriage witnessed by a priest? Yes No

If no, was dispensation granted? Yes No

Gender Please enter valid data.

Ethnic Origin Please enter valid data.

Occupation Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Church Attendance REQUIRED Please fill out this field.

Sacraments Received REQUIRED Baptism First Penance First Communion Confirmation Please fill out this field.

Spouse's Gender Please enter valid data.

Spouse's Ethnic Origin Please enter valid data.

Spouse's Occupation Please enter valid data.

Spouse's Religion Please enter valid data.

Spouse's Sacraments Received Baptism First Penance First Communion Confirmation

Are there any personal skills or talents you would like to offer to our parish community?

Are there any specific areas of pastoral service you are interested in becoming involved in at our parish?

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Saint Elizabeth Parish