*Please make sure each catholic resident of the home fills out this form separately.

Full Name

Address

Phone Number

Male or Female

Male Female

Marital Status

Married
Single
Widow/er
Separated
Divorced
Common Law

Date of Birth

Month
Day
Year

First Communion

Yes
No

First Penance

Yes
No

Confirmed

Yes
No

Are you presently involved in the Parish in any way? (Ministries/Committees/Parish Groups)

Yes
No

If yes, please explain

If no, would you be interested in becoming involved?

Yes
No

Would you like a visit from the Parish Priest?

Yes
No

Comments/Concerns