New Parishioner Registration

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Location

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

How do you want your mailing label addressed? Mr. Mrs. Mr. & Mrs. Ms. Dr. Dr. & Mrs. Other

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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.

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

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

Marital Status Married in Catholic Church Civil Only Marriage Single Widowed Divorced Separated

How would you like to tithe? Receive contribution envelopes in the mail Recurring automatic offering

Family members living in your home REQUIRED Please fill out this field.
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No
Name 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.
- M/F Male Female
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Religion Please enter valid data.
- Baptized Yes No
- First Communion Yes No
- Confirmation Yes No

Divine Mercy

Catholic Church

New Parishioner Registration

Welcome to Divine Mercy Parish