Parish Registration

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

Home 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. Please enter valid data.

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

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

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

Head of Household REQUIRED Please fill out this field.

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(month/date/year) REQUIRED Please fill out this field. Please enter a date.

Sex REQUIRED Male Female Please fill out this field.

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

Church Attendance

Sacraments Recieved

Choose all that apply

Baptism First Communion Confirmation Marriage None

Parish and Place of Baptism Please enter valid data.

Occupation Please enter valid data.

Interested in ministries?

Spouse (if any)

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth(month/date/year) Please enter a date.

Religion Please enter valid data.

Sacraments Recieved

Choose all that apply

Baptism First Communion Confirmation Marriage None

Parish and Place of Baptism Please enter valid data.

Child/Other Member

First Name Please enter valid data.

Last Name Please enter valid data.

Sex Male Female

Date of Birth ( month/date/year) Please enter a date.

Religion Please enter valid data.

Sacraments Recieved

Choose all that apply

Baptism First Communion Confirmation Marriage None

More Children?

Enter Number of Children

Please enter an integer (number).

Children's Names/Dates of Birth/Sacrament Information

Comments

Church of the Assumption 1227 7th Ave N