HOLY NAME
CATHOLIC CHURCH

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PARISH REGISTRATION FORM

- Our Parish

Are you new to our parish? Have you been a "parishioner", but have never registered? If you would like to update your information, please fill out the form below.
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- Family/Last Name REQUIRED Please fill out this field. Please enter valid data.
- First & Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name, if applicable Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Gender REQUIRED Male Female Please fill out this field.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email Please enter an email address.
- Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Preferred mode of communication Email Text Paper
- Preferred mode of tithing Tithing Envelopes Online Giving (please checkout the Online Giving tab)
- Marital Status Single Married Widowed Separated Divorced
- Occupation Please enter valid data.
- Religion Please enter valid data.
- Sacraments
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
  
  Catholic Matrimony? Yes No
  
  Married - Other/Civil? Yes No
- Spouse
- Family/Last Name Please enter valid data.
- First & Middle Name Please enter valid data.
- Maiden Name, if applicable Please enter valid data.
- Date of Birth Please enter a date.
- Gender Male Female
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email Please enter an email address.
- Marital Status Single Married Widowed Separated Divorced
- Occupation Please enter valid data.
- Religion Please enter valid data.
- Sacraments
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
  
  Catholic Matrimony? Yes No
  
  Married - Other/Civil? Yes No
- Additional Family Members
  
  First & Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
- Additional Family Members
  
  First & Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
- Additional Family Members
  
  First & Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
- Additional Family Members
  
  First & Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
- Additional Family Members
  
  First & Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
- Additional Family Members
  
  First & Middle Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter a date.
  
  Gender Male Female
  
  Religion Please enter valid data.
  
  Baptized? Yes No
  
  1st Holy Communion? Yes No
  
  Penance/Reconciliation? Yes No
  
  Confirmed? Yes No
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