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  • Family Name REQUIRED Please fill out this field. Please enter valid data.
  • Mailing Name REQUIRED Please fill out this field. Please enter valid data.
  • Choose one REQUIRED (Select One) Mr. & Mrs. Mr. Mrs. Ms. Miss Please fill out this field.
  • Address 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.
  • Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  • Email REQUIRED Please fill out this field. Please enter an email address.
  • First language REQUIRED Please fill out this field. Please enter valid data.
  • Second language Please enter valid data.
  • Church now attending REQUIRED Please fill out this field. Please enter valid data.
  • Address REQUIRED Please fill out this field. Please enter valid data.
  • How many years did you live in that parish? REQUIRED Please fill out this field. Please enter valid data.
  • Are you a registered member? REQUIRED Please fill out this field. Please enter valid data.
  • Do you have additional family members registered at other churches? None Yes No
  • Name & Church Please enter valid data.
  • Name and Church Please enter valid data.
  • Which parish do you wish to register? Choose one. REQUIRED (Select One) Immaculate Conception Church Holy Spirit Church Please fill out this field.
  • Status REQUIRED (Select One) Married Widowed Separated Divorced Single Remarried Please fill out this field.
  • Name of Former Spouse Please enter valid data.
  • Name of church where married Please enter valid data.
  • Address of church where married Please enter valid data.
  • City Please enter valid data.

    State None 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

    Zip Please enter a zip code.
  • Date of marriage Please enter valid data.
  • Married by: Choose one. None Catholic Priest/Deacon Minister Justice of the Peace Other
  • If other, was it performed with permission? Please enter valid data.
  • Was it convalidated? None Yes No
  • If yes, add name and place of convalidation. Please enter valid data.
  • • Number of Family Members REQUIRED Please fill out this field.
    • Family Member 1
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 2
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 3
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 4
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 5
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 6
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 7
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 8
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 9
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 10
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 11
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
    • Family Member 12
      • First Name REQUIRED Please fill out this field. Please enter valid data.

        Last Name REQUIRED Please fill out this field. Please enter valid data.
      • Adult/Child/Other: Check one. Male Head of Household Female Head of Household Child living at home, away at school or in the service Other person living with you
      • Maiden name Please enter valid data.
      • Date of Birth REQUIRED Please fill out this field. Please enter a date.
      • Occupation Please enter valid data.
      • School attending Please enter valid data.
      • Attending Religious Education? None Yes No
      • Special Needs? Please enter valid data.
      • Religion Please enter valid data.
      • Check sacraments made Baptized 1st Penance 1st Communion Confirmation
      • Date of Baptism Please enter a date.
  • Baptism Church Name/Place Please enter valid data.

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