Family Registration Form

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

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 Language English Spanish Dinka or Other

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Husband's Information

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth Please enter valid data.

Place of Birth Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email Please enter valid data.

Please check all sacraments that you have received: Baptism First Holy Communion Confirmation

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Wife's Information
*Please put Maiden Name for Last Name*

First Name Please enter valid data.

Last Name Please enter valid data.

Date of Birth Please enter valid data.

Place of Birth Please enter valid data.

Phone Number Please enter a phone number.

Email Please enter valid data.

Please check all sacraments that you have received: Baptism First Holy Communion Confirmation

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Are you married? REQUIRED Yes No Please fill out this field.

Would you like to keep track of your donations by using our envelopes? REQUIRED Yes No - I will consider online giving instead Please fill out this field.

If Interested, when you are done registering, please visit our online giving section to sign up. Thanks

Which Mass do you attend? Saturday 5pm Sunday 8am Sunday 10am Sunday 12pm

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Childrens' Information Below