BLESSED SACRAMENT CATHOLIC COMMUNITY – CONVENTUAL FRANCISCAN FRIARS

1620 Hanford Road, Graham, NC 27253 (336) 226-8796

Mailing Address: P.O. Box 619, Burlington, NC 27216

Date ______How would you like to support your parish?

Offertory envelopes ______Online giving ______

Household Last Name ______

Address ______

Street name (apartment or lot number, if applicable) City State Zip Code

Home Phone ______Cell ______E-mail ______

1st Adult: Title ______Name ______Date of Birth ______

Ms., Mrs., Mr., Dr., etc.) (first, middle, maiden name for women, last)

Marital Status (circle one) Single Married Widowed Separated Divorced

(If married, were you married by a Catholic Priest ______or civilly ______Date of Marriage or convalidation ______

Occupation ______Place of Employment ______

Religion ______If Catholic, are you: Baptized_____, Received 1st Communion_____, Been Confirmed_____

Previous Parish Involvements/Ministries ______

2nd Adult: Title ______Name ______Date of Birth ______

(Ms., Mrs., Mr., Dr., etc.) (first, middle, maiden name for women, last)

Marital Status (circle one) Single Married Widowed Separated Divorced

Occupation ______Place of Employment ______

Religion ______If Catholic, are you: Baptized_____, Received 1st Communion_____, Been Confirmed_____

Previous Parish Involvements/Ministries ______

(over)

Year Household moved to this area ______Name of Parish Transferring from ______

Unmarried children residing at this address

Sacraments received: (Please answer yes or no)

Name /
Date of Birth
mm/dd/year /

Religion

/ Baptism / First
Communion /

Confirmation

/ School /

Age

Others living at this address and their relationship (mother, father, friend, etc.)

______

Is any member of your household fluent in a language other than English? (circle one) Yes No

If yes, who, and what language? ______

Please indicate ANY special needs you or your family may have, with which the parish might assist:

______

______

Additional Comments:

(Please mail or drop off completed form to the parish office. Form may also be placed in the collection basket at Mass)