New Parishioner Registration

- About

Welcome to Divine Mercy Parish

If you would like to register as a member of Divine Mercy Parish, please fill out the form below.
We look forward to meeting you and your family!
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- Type REQUIRED Please fill out this field.
- 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
- 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.
- 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.
- 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
- If you would like more information about our ministries, please check the box(es) and a representative will contact you CCD: PreK to Confirmation CCD: Becoming a Catechist RCIA/RCIC: Seeking initiation into the Church RCIA: Becoming a Catechist Altar Server Lector Eucharistic Minister Music Usher/Greeter Prayer Group/Prayer Line Altar Flowers Altar Setup/Takedown Building Fund Committee Hospitality Knights of Columbus Catholic Daughters of the Americas Liturgy Committee Raphael Ministry
- 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
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