St. Mary Roman Catholic Church
Parishioner Registration Form
3334B University Avenue, Morgantown, WV 26505 Phone: (304) 599-3747 email:
Family Information
Last Name: / First: Registration Date: / /
Family Email: Home Phone: ( ) -
Address Information
Home Address:
City: / State: / Zip: / -
Mailing Address:
(if different from home address) City: / State: Zip: -

Please check all that apply

 OK to Publish Phone  OK to Publish Address  OK to Publish Email

Please Print all answers,

If any unknown information, leave field blank.

Please fold and mail to the Parish Office at the above address, or drop into regular collection when complete

Head of Household Information
Last Name: / First: Middle: Preferred/Nick Name:
Status at Parish:  Active  Inactive / Gender: Male Female
Date of Birth: / / Birth Place: Maiden Name:
Member Email: Cell Phone: ( ) - Work Phone: ( ) -
Religion: Catholic  Other:______Marital Status: Married:  By Priest  Not by Priest Date:______
Occupation: /  Single  Divorced  Widowed
School attended/ attending: Highest or Present Grade or Degree:
Sacramental Information
 Baptism / / Church Name, City, State:
First Reconciliation / / Church Name, City, State:
First Eucharist / / Church Name, City, State:
 Confirmation / / Church Name, City, State:
 Catholic Marriage / / Church Name, City, State:
Member #2 Living at Same address
Last Name: / First: Middle: Preferred/Nick Name:
Relationship to Head of Household:  Spouse  Son  Daughter  Other: ______
Status at Parish:  Active  Inactive / Gender: Male Female
Date of Birth: / / Birth Place: Maiden Name:
Member Email: Cell Phone: ( ) - Work Phone: ( ) -
Religion: Catholic  Other:______Marital Status: Married:  By Priest  Not by Priest Date:______
Occupation: /  Single  Divorced  Widowed
School attended/attending: / Highest or Present Grade or Degree:
Sacramental Information
 Baptism / / Church Name, City, State:
First Reconciliation / / Church Name, City, State:
 First Eucharist / / Church Name, City, State:
 Confirmation / / Church Name, City, State:
 Catholic Marriage / / Church Name, City, State:
Member #3 Living at Same address
Last Name: / First: Middle: Preferred/Nick Name:
Relationship to Head of Household:  Spouse  Son  Daughter  Other: ______
Status at Parish:  Active  Inactive / Gender: Male Female
Date of Birth: / / Birth Place: Maiden Name:
Member Email: Cell Phone: ( ) - Work Phone: ( ) -
Religion: Catholic  Other:______Marital Status: Married:  By Priest  Not by Priest Date:______
Occupation: /  Single  Divorced  Widowed
School attended/attending: / Highest or Present Grade or Degree:
Sacramental Information
 Baptism / / Church Name, City, State:
First Reconciliation / / Church Name, City, State:
 First Eucharist / / Church Name, City, State:
 Confirmation / / Church Name, City, State:
 Catholic Marriage / / Church Name, City, State:
Member #4 Living at Same address
Last Name: / First: Middle: Preferred/Nick Name:
Relationship to Head of Household:  Spouse  Son  Daughter  Other: ______
Status at Parish:  Active  Inactive / Gender: Male Female
Date of Birth: / / Birth Place: Maiden Name:
Member Email: Cell Phone: ( ) - Work Phone: ( ) -
Religion: Catholic  Other:______Marital Status: Married:  By Priest  Not by Priest Date:______
Occupation: /  Single  Divorced  Widowed
School attended/attending: / Highest or Present Grade or Degree:
Sacramental Information
 Baptism / / Church Name, City, State:
First Reconciliation / / Church Name, City, State:
 First Eucharist / / Church Name, City, State:
 Confirmation / / Church Name, City, State:
 Catholic Marriage / / Church Name, City, State:
Member #5 Living at Same address
Last Name: / First: Middle: Preferred/Nick Name:
Relationship to Head of Household:  Spouse  Son  Daughter  Other: ______
Status at Parish:  Active  Inactive / Gender: Male Female
Date of Birth: / / Birth Place: Maiden Name:
Member Email: Cell Phone: ( ) - Work Phone: ( ) -
Religion: Catholic  Other:______Marital Status: Married:  By Priest  Not by Priest Date:______
Occupation: /  Single  Divorced  Widowed
School attended/attending: / Highest or Present Grade or Degree:
Sacramental Information
 Baptism / / Church Name, City, State:
First Reconciliation / / Church Name, City, State:
 First Eucharist / / Church Name, City, State:
 Confirmation / / Church Name, City, State:
 Catholic Marriage / / Church Name, City, State: