Family Registration Form

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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
_________________________
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 Maximum 20 characters Please enter a phone number.
Email Please enter valid data.
Please check all sacraments that you have received: Baptism First Holy Communion Confirmation
_________________________
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 Maximum 20 characters Please enter a phone number.
Email Please enter valid data.
Please check all sacraments that you have received: Baptism First Holy Communion Confirmation
________________________
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.
Would you like to sign up to receive our flocknotes? (This includes, events, newsletters, etc.) REQUIRED Yes, I want to receive to my cellphone via text Yes, I want to receive to my email No - I do not want to stay informed Please fill out this field.
Primary Phone Number REQUIRED Please fill out this field. Please enter valid data.
Primary Email REQUIRED Please fill out this field. Please enter valid data.
If Interested, when you are done registering, please visit our online giving section to sign up. Thanks
Which Mass do you attend? Saturday 5pm (English) Sunday 9:30am (English) Sunday 12pm (Spanish)
_________________________
Childrens' Information Below
- Number of children in the household REQUIRED Please fill out this field.
- Child 1
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation
- Child 2
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation
- Child 3
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation
- Child 4
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation
- Child 5
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation
- Child 6
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation
- Child 7
  - Name Please enter valid data.
  - Date of Birth Please enter valid data.
  - School Grade Level Please enter valid data.
  - Please check all sacraments that your child has received Baptism First Holy Communion Confirmation

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