R.C.I.A. REGISTRATION FORM
R.C.I.A. CANDIDATE:Name
FIRST MID LAST MAIDEN
Phone email:
HOME/CELL/WORK
Address
STREETCITYSTATEZIP
Date of BirthPlace of Birth
CITYSTATE
Father’s name
FIRSTLAST
Mother’s name
FIRSTLASTMAIDEN
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A. BAPTISM, EUCHARIST AND CONFIRMATION INFORMATION
1. Were you ever Christened, Baptized, or Sprinkled ?_____ If yes-bring a copy of your Baptismal Certificate
Date Place
CHURCHCITYSTATE
2. Have you made your First Communion?_____ Date ______Place
CHURCHCITYSTATE
3. Were you ever confirmed?_____ Date ______Place
CHURCHCITYSTATE
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B. MARRIAGE INFORMATION
Are you married? Spouse’s name
Religion Were you married by a Catholic Priest or a Deacon?
Place of Marriage
CHURCH/OTHERCITYSTATE
* Have you everbeen married before? ____ How many times? Divorced how many times? ____
* Has your spouse ever been married before? ___ How many times? ____ Divorced how many times?___
See back to complete information on spouse:
If you have been divorced, please list information of each divorce beginning with the first marriage and divorce on the lines below. (If a former spouse is dead please supply a death certificate.)
1.a. Date of marriage and divorce
b. Name of former spouse/spouses ______
______
c. Living or deceased ______If deceased skip questions d and e.
d. What was his/her baptismal status at the time of marriage?______If baptized, do you know name
and address of church?______
2.a. Date of marriage and divorce
b. Name of former spouse/spouses ______
______
c. Living or deceased ______If deceased skip questions d and e.
d. What was his/her baptismal status at the time of marriage?______If baptized, do you know name
and address of church?______
C SPOUSE INFORMATION: If your spouse has been divorced, please list information of each divorce
beginning with the first marriage and divorce on the lines below. (If a former spouse is dead please supply a
death certificate.)
1.a. Date of marriage and divorce
b. Name of former spouse/spouses ______
______
c. Living or deceased ______If deceased skip questions d and e.
d. What was his/her baptismal status at the time of marriage?______If baptized, do you know name
and address of church?______
2.a. Date of marriage and divorce
b. Name of former spouse/spouses ______
______
c. Living or deceased ______If deceased skip questions d and e.
d. What was his/her baptismal status at the time of marriage?______If baptized, do you know name
and address of church?______
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D. R.C.I.A. SPONSOR
Sponsor’s name______Phone #
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OFFICE USE
DATE OF SACRAMENTS RECEIVED AT ST. PIUS X:
BAPTISM PROFESSION OF FAITH FIRST EUCHARIST CONFIRMATION / SAINT NAME
______/______
BLESSED MARRIAGE
______