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Adults in the Household (See page 2 for children)
Information / Adult #1 (Primary Registrant) / Adult #2
*First Name
*Last Name
(if different from above)
Grade/Degree
Gender
Marital Status
(see codes below)
*Date of Birth
Language
Religion
Occupation / Skills
*Email
*Cell # or Other #
Sacraments
Received / ☐ Baptism ☐ Confirmation
☐ First Communion ☐ Matrimony / ☐ Baptism ☐ Confirmation
☐ First Communion ☐ Matrimony

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*Last Name / *Home Phone # / Previous Parish Information
*Address / Apt. # / Parish Name
*City / *State / *Zip Code / City/State
Children in the Household
Information / Child #1 / Child #2 / Child #3 / Child #4
First Name
Last Name (if different)
Gender
Date of Birth
Grade/Degree
Catholic School? (Y/N)
Religion
Special Needs
Email (church use only)
Cell # or Other #
Sacraments
Received / ☐ Baptism ☐ Confirmation
☐ First Communion
☐ Matrimony / ☐ Baptism ☐ Confirmation
☐ First Communion
☐ Matrimony / ☐ Baptism ☐ Confirmation
☐ First Communion
☐ Matrimony / ☐ Baptism ☐ Confirmation
☐ First Communion
☐ Matrimony