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  • Family Last Name REQUIRED Please fill out this field. Please enter valid data.
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  • Head of Household
    • Name REQUIRED Please fill out this field. Please enter valid data.
    • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
    • Religion None Catholic Baptist Episcopalian Lutheran Methodist Presbyterian Pentecostal Other
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    • Marriage None Catholic Church Marriage Other Church Marriage Civil Marriage Single Separated Divorced Widowed
    • Date of Marriage

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    • Baptism REQUIRED Yes No Please fill out this field.
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    • First Communion REQUIRED Yes No Please fill out this field.
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    • Confirmation REQUIRED Yes No Please fill out this field.
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  • Spouse [if any]
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    • Religion None Catholic Baptist Episcopalian Lutheran Methodist Presbyterian Pentecostal Other
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    • Occupation Please enter valid data.
    • Marriage None Catholic Church Marriage Other Church Marriage Civil Marriage Single Separated Divorced Widowed
    • Date of Marriage

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    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Dependent Children (Oldest to Youngest)
    • Name Please enter valid data.
    • Date of Birth Please enter valid data.
    • Religion None Catholic Methodist Lutheran Episcopalian Baptist Presbyterian Pentecostal Other
    • Gender Male Female
    • Currently Receiving Religious Instruction None Catholic School CCD Program Home School None
    • Current Grade Please enter valid data.
    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
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    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Child/Other Member
    • Name Please enter valid data.
    • Date of Birth Please enter valid data.
    • Religion None Catholic Methodist Lutheran Episcopalian Baptist Presbyterian Pentecostal Other
    • Gender Male Female
    • Currently Receiving Religious Instruction None Catholic School CCD Program Home School None
    • Current Grade Please enter valid data.
    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Child/Other Member
    • Name Please enter valid data.
    • Date of Birth Please enter valid data.
    • Religion None Catholic Methodist Lutheran Episcopalian Baptist Presbyterian Pentecostal Other
    • Gender Male Female
    • Currently Receiving Religious Instruction None Catholic School CCD Program Home School None
    • Current Grade Please enter valid data.
    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Child/Other Member
    • Name Please enter valid data.
    • Date of Birth Please enter valid data.
    • Religion None Catholic Methodist Lutheran Episcopalian Baptist Presbyterian Pentecostal Other
    • Gender Male Female
    • Currently Receiving Religious Instruction None Catholic School CCD Program Home School None
    • Current Grade Please enter valid data.
    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Child/Other Member
    • Name Please enter valid data.
    • Date of Birth Please enter valid data.
    • Religion None Catholic Methodist Lutheran Episcopalian Baptist Presbyterian Pentecostal Other
    • Gender Male Female
    • Currently Receiving Religious Instruction None Catholic School CCD Program Home School None
    • Current Grade Please enter valid data.
    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Other Adults In Home
    • Name Please enter valid data.
    • Date of Birth Please enter valid data.
    • Religion None Catholic Baptist Episcopalian Lutheran Methodist Presbyterian Pentecostal Other
    • If selected "Other" above: Please enter valid data.
    • Occupation Please enter valid data.
    • Marriage None Catholic Church Marriage Other Church Marriage Civil Marriage Single Separated Divorced Widowed
    • Date of Marriage

      Provide date if Married

      Please enter valid data.
    • Baptism Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • First Communion Yes No
    • If "Yes", Provide Date: Please enter valid data.
    • Confirmation Yes No
    • If "Yes", Provide Date: Please enter valid data.
  • Other
    • I wish to discuss with priest regarding:
    • I am interested in the following: Sacramental Instruction Shut-In Ministry Retreats Religious Education Volunteer Opportunities Youth Activities R.C.I.A. Program Other
    • If "Other":

      Please list all that apply!

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