Check this box if you want your e-mail address published in the parish directory. —Online Registration Form— Local Address Street Address: City: State: Zip: Mailing  Address (if different): City: State: Zip: Primary Phone: Second Residence Address: City: State: Zip: Phone: Dates at 2nd Residence: From: To: Send mail to 2nd Residence during this time? ►Family Member to notify in emergency: Your Name: Marital Status: Religion: Gender: Date of Birth: Occupation: Business Location: Business Phone: Baptism: Location: 1st Comm: Location: Penance: Location: Confirmed: Location: Marriage: Location: Spouse’s Name: Marital Status: Religion: Gender: Date of Birth: Occupation: Business Location: Business Phone: Sacraments  (for above member) FOR  OFFICE  USE  ONLY ID/ENV: ________________ ENTERED BY: __________ Family Name: Baptism: Location: 1st Comm: Location: Penance: Location: Confirmed: Location: Marriage: Location: Sacraments  (for above member) E-mail Address (for official Church information only): If you have recently joined our parish, from where did you move? City, State: Parish: (The parish office will not divulge e-mail addresses unless permission has been checked.) How many people are in your household? All Catholic?