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FAMILY LAST NAME ___________________________________________ ENV# ___________ ST. HELEN OF THE CROSS CATHOLIC CHURCH FAMILY REGISTRATION FORM FAMILY NAME: Head of Household Parishioners Since: _______________________________ First Name: _____________________________________ Last Name: _____________________________________ Title: _______________________ Suffix ______Occupation: _____________________________________________ Baptism: YES or NO Date:__________________________Parish : ____________________________ City: ________________________ State: ________________ Confirmation: YES or No Date:_________________________ Parish: ____________________________ City: ________________________ State: ________________ 1st Holy Communion: YES or NO Date:__________________________ Parish: ____________________________ City: ________________________ State: ________________ Spouse: First Name: _______________________________________Last Name: ___________________________________ Title: _______________________ Occupation: ______________________________ Baptism: YES or NO Date:__________________________Parish : ______________________ City: ________________________ State: ________ Confirmation: YES or No Date:_________________________ Parish: _______________________ City: ________________________ State: ________ 1st Holy Communion: YES or NO Date:__________________________ Parish: ______________________ City: ________________________ State: ________ Marriage: Date:__________________________ Parish: ________________________________________ City: ________________________ State: ________ Mailing Name:_____________________________________________________ EX.: Mr. & Mrs. John Smith Marital Status: (circle one) Church * Civil * Single * Divorced * Widow * Co-Habitating 1 FAMILY INFORMATION: Street Address: _____________________________________________________________________________ City _____________________________ State: ____________________ Zip Code: ______________________ Mailing Address: ___________________________________________________________________________ City _____________________________ State: ____________________ Zip Code: ______________________ --------------------------------------------------------------------------------------------------------------------------------------- Summer Address: ___________________________________________________________________________ City _____________________________ State: ____________________ Zip Code: ______________________ FROM: Month: _________ Day: _______ TO: Month: _________ Day: _________ -------------------------------------------------------------------------------------------------------------------------------------- Phone # ( ) ___________________________________ Home / Office / Cell / Other Phone # ( ) ___________________________________ Home / Office / Cell / Other E-Mail Address: ____________________________________________________________________________ --------------------------------------------------------------------------------------------------------------------------------------- OTHER FAMILY MEMBERS: Last Name: _________________________________ First Name: __________________________________ Gender: Male / Female Date of Birth: ____________________________________ SACRAMENT INFORMATION: Baptism: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Confirmation: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Communion: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ 2 OTHER FAMILY MEMBERS: Last Name: ___________________________ First Name: __________________________________ Gender: Male / Female Date of Birth: ____________________________________ SACRAMENT INFORMATION: Baptism: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Confirmation: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Communion: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ ----------------------------------------------------------------------------------------------------------------------------- OTHER FAMILY MEMBERS: Last Name: ___________________________ First Name: __________________________________ Gender: Male / Female Date of Birth: ____________________________________ SACRAMENT INFORMATION: Baptism: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Confirmation: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Communion: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ 3 OTHER FAMILY MEMBERS: Last Name: ___________________________ First Name: __________________________________ Gender: Male / Female Date of Birth: ____________________________________ SACRAMENT INFORMATION: Baptism: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Confirmation: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ Communion: Church: _______________________________ City ___________________State: ____ Month: _________________________ Day: __________ Year _________________ MASS ATTENDANCE: (Please Circle One) Regular Special Occasion Monthly Bi-Monthly Twice a Year MASS TIME PREFERENCE: _________________________________________________________ Would you like to receive parish envelopes? (Please Circle One) YES or NO Would you prefer to have your donation made with: (Please Circle One) Electronic Fund Transfer Credit Card Check Cash Comments:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ 4
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Registration Form
