Online Registration

Family Contact Info

Family Last Name REQUIRED Please fill out this field. Please enter valid data.
Street 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.
Mailing 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 Email Please enter valid data.
Preferred Contact Phone Number Maximum 20 characters Please enter a phone number.
Preferred Language (English/Spanish) REQUIRED English Spanish Bilingual, prefer English Bilingual, prefer Spanish Please fill out this field.
Would you like for St. Patrick to be your primary parish? REQUIRED We are already registered as members at St. Patrick. Yes, we'd like to be members at St. Patrick. No, we prefer to keep another parish as our home parish. Yes, please order church envelopes. No church envelopes. Please fill out this field.

Parent(s) / Head(s) of Household

Marital Status Single Married in the Catholic Church Married outside the Catholic Church (civil, commonlaw, Protestant ceremony, or non-Christian faith) Divorced Widowed

Self

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Gender REQUIRED Male Female Please fill out this field.
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation Marriage in the Catholic Church Ordination (Deacon)
Occupation/Employer Please enter valid data.
Work Phone Number Maximum 20 characters Please enter a phone number.
Cell Phone Number Maximum 20 characters Please enter a phone number.
Preferred Phone Number

Spouse (or other adult in the home)

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation Marriage in the Catholic Church Ordination (Deacon)
Occupation/Employer Please enter valid data.
Work Phone Number Maximum 20 characters Please enter a phone number.
Cell Phone Number Maximum 20 characters Please enter a phone number.
Preferred Phone Number

Child #1

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation
Grade Level
Register for Religious Education classes? Yes No

Child #2

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation
Grade Level
Register for Religious Education classes? Yes No

Child #3

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation
Grade Level
Register for Religious Education classes? Yes No

Child #4

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation
Grade Level
Register for Religious Education classes? Yes No

Child #5

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation
Grade Level
Register for Religious Education classes? Yes No

Child #6

First Name Please enter valid data.

Last Name Please enter valid data.
Gender Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation
Grade Level
Register for Religious Education classes? Yes No

Are there any homebound/disabled in the home? Please list their name(s).