Parish Registration

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

Mailing Address REQUIRED Please fill out this field. Please enter valid data.

Street Address (if not mailing address) Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

Zip REQUIRED Please fill out this field. Please enter an integer (number).

Primary Phone REQUIRED Please fill out this field. Please enter valid data.

Cell Phone Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Ministries you are interested in joining?

Other Info

Part-time/Summer Parishioners (please fill out 5 lines below)

Head of Household

Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.
Marital Status REQUIRED Please fill out this field.
Marriage Info REQUIRED Please fill out this field.
Marriage Date Please enter valid data.
Sacraments Received REQUIRED
Select Highest Level
Baptism First Communion Confirmation Please fill out this field.
Church of Baptism REQUIRED Please fill out this field. Please enter valid data.
City of Baptism Please enter valid data.
State of Baptism
Occupation REQUIRED Please fill out this field. Please enter valid data.

Spouse [if any]

Child/Other Member/Living at Home

Child/Other Member/Living at Home

Child/Other Member/Living at Home

Child/Other Member/Living at Home

St. Charles Borromeo