• 2019 Parish Census Form

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  • Family Last Name: REQUIRED Please fill out this field. Please enter valid data.
  • I am a parishioner, please update my information Check box
  • First Name REQUIRED Please fill out this field. Please enter valid data.

    Last Name REQUIRED Please fill out this field. Please enter valid data.
  • City REQUIRED Please fill out this field. Please enter valid data.

    State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

    Zip REQUIRED Please fill out this field. Please enter a zip code.
  • Home or Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.
  • Email Please enter an email address.
  • Yes, I would like to receive information on parish events via email check box
  • Do you receive Envelopes? REQUIRED (Select One) Yes No Please fill out this field.
  • If so, Envelope # Please enter valid data.
  • Head of Household
  • First Name, MI, Last Name REQUIRED Please fill out this field. Please enter valid data.
  • Maiden Name Please enter valid data.
  • Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  • Male / Female REQUIRED (Select One) Male Female Please fill out this field.
  • Denomination REQUIRED (Select One) Catholic Other Please fill out this field.
  • Please type denomination if not Catholic Please enter valid data.
  • Mobile Phone Number Please enter a phone number.
  • Work Phone Number Please enter a phone number.
  • Email Please enter an email address.
  • Ethnicity/Race Category (select all that apply) White(German, Irish, English, Italian, French, etc) Black or African Am,(Jamaican, Nigerian, African American, etc) Hispanic / Latino (Mexican, Puerto Rican, Cuban, etc) Asian (Chinese, Fillipino, Vietnamese, Asian Indian, etc) American Indian or Alaska Native Middle Eastern/North African (Lebanese, Iranian, Egyptian, etc.) Native Hawaiian or Pacific Islander Some other race, ethnicity or origin
  • Please type other race/ethnicity if applicable Please enter valid data.
  • Catholic Baptism None Yes No
  • Where were you baptized? Please enter valid data.
  • Received First Communion? None Yes No
  • Received Confirmation? None Yes No
  • Maritial Status None Single Married Divorced Widow
  • Date of Marriage (if applicable) Please enter valid data.
  • Were you married by a Priest? None Yes No
  • Are you House Bound? None Yes No
  • Are you in a nursing home? None Yes No
  • I would like to voluneer for the following skills/ministries: Please enter valid data.
  • Spouse (if applicable)
  • First Name, MI, Last Name Please enter valid data.
  • Maiden Name Please enter valid data.
  • Date of Birth Please enter valid data.
  • Male / Female None Male Female
  • Denomination None Catholic Baptist Other Methodist Non-Demonimation
  • Please type denomination if not Catholic Please enter valid data.
  • Mobile Phone Number Please enter a phone number.
  • Work Phone Number Please enter a phone number.
  • Email Please enter an email address.
  • Ethnicity/Race Category (select all that apply) White(German, Irish, English, Italian, French, etc) Black or African Am,(Jamaican, Nigerian, African American, etc) Hispanic / Latino (Mexican, Puerto Rican, Cuban, etc) Asian (Chinese, Fillipino, Vietnamese, Asian Indian, etc) American Indian or Alaska Native Middle Eastern/North African (Lebanese, Iranian, Egyptian, etc.) Native Hawaiian or Pacific Islander Some other race, ethnicity or origin
  • Please type other race/ethnicity if applicable Please enter valid data.
  • Catholic Baptism None Yes No
  • Where were you baptized? Please enter valid data.
  • Received First Communion? None Yes No
  • Received Confirmation? None Yes No
  • Are you House Bound? None Yes No
  • Are you in a nursing home? None Yes No
  • I would like to voluneer for the following skills/ministries: Please enter valid data.
  • Dependent Children
    (under 18 who reside with you)
  • First Name, MI, Last Name (Child 1) Please enter valid data.
  • Date of Birth Please enter valid data.
  • Male / Female None Male Female
  • Catholic Baptism None Yes No
  • Where was child baptized? Please enter valid data.
  • Received First Communion? None Yes No
  • Received Confirmation? None Yes No
  • Name of school attending Please enter valid data.
  • First Name, MI, Last Name (Child 2) Please enter valid data.
  • Date of Birth Please enter valid data.
  • Male / Female None Male Female
  • Catholic Baptism None Yes No
  • Where was child baptized? Please enter valid data.
  • Received First Communion? None Yes No
  • Received Confirmation? None Yes No
  • Name of school attending Please enter valid data.
  • First Name, MI, Last Name (Child 3) Please enter valid data.
  • Date of Birth Please enter valid data.
  • Male / Female None Male Female
  • Catholic Baptism None Yes No
  • Where was child baptized? Please enter valid data.
  • Received First Communion? None Yes No
  • Received Confirmation? None Yes No
  • Name of school attending Please enter valid data.

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