Parish Registration Status* New Registration Update or correction Date MM slash DD slash YYYY Family Last Name* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*TYPE OF HOUSEHOLD* Adults and children Adults only 1 Adult Single parent Other Head of HouseholdName* Mr.Mrs.Ms.Dr. Prefix First Middle Initial Last Marital status* Married Single Divorced Widowed Date of birth* MM slash DD slash YYYY Occupation Gender Male Female Race or Origin (Optional) PhoneEmail* Catholic? Yes No Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Other Married by a priest? Yes No Marriage date and place SpouseName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Middle Initial Last Date of birth* MM slash DD slash YYYY Occupation Gender Male Female Race or Origin (Optional) PhoneEmail Catholic? Yes No Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Other Children/Others in HouseholdNumber of children/others in Household*01234567+Child/Other 1Name* First Last Date of Birth MM slash DD slash YYYY Gender Male Female Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Relationship Son Daughter Other Child/Other 2Name* First Last Date of Birth MM slash DD slash YYYY Gender Male Female Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Relationship Son Daughter Other Child/Other 3Name* First Last Date of Birth MM slash DD slash YYYY Gender Male Female Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Relationship Son Daughter Other Child/Other 4Name* First Last Date of Birth MM slash DD slash YYYY Gender Male Female Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Relationship Son Daughter Other Child/Other 5Name* First Last Date of Birth MM slash DD slash YYYY Gender Male Female Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Relationship Son Daughter Other Child/Other 6Name* First Last Date of Birth MM slash DD slash YYYY Gender Male Female Baptized? Yes No Received 1st Communion? Yes No Confirmed? Yes No Relationship Son Daughter Other Additional Children/OthersNames, ages, and sacramental history of children/others in the household
