Family Last Name(s)* Wife's Maiden Name Home Phone*Work PhoneEmail* Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Neighborhood or Development Would you like to receive Weekly offering Envelopes? Yes Adults 21 and Over & All Married PersonsNumber of Adults 21 and Over & All Married Persons in Household*1234Adult #1Enter information below for the an adult in this household (over 21 or married person)Name*(Include last name if other than family name above) Name MI Nickname Occupation Sex* Male Female Date of Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneMarital Status*MarriedSingleSeparatedDivorcedWidowedBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No Marriage By Catholic Priest Yes No Education Highest Level Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Adult #2Enter information below for the an adult in this household (over 21 or married person)Name*(Include last name if other than family name above) Name MI Nickname Occupation Sex* Male Female Date of Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneMarital Status*MarriedSingleSeparatedDivorcedWidowedBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No Marriage By Catholic Priest Yes No Education Highest Level Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Adult #3Enter information below for the an adult in this household (over 21 or married person)Name*(Include last name if other than family name above) Name MI Nickname Occupation Sex* Male Female Date of Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneMarital Status*MarriedSingleSeparatedDivorcedWidowedBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No Marriage By Catholic Priest Yes No Education Highest Level Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Adult #4Enter information below for the an adult in this household (over 21 or married person)Name*(Include last name if other than family name above) Name MI Nickname Occupation Sex* Male Female Date of Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneMarital Status*MarriedSingleSeparatedDivorcedWidowedBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No Marriage By Catholic Priest Yes No Education Highest Level Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Unmarried Person Under 21Number of Unmarried Persons Under 21 in Household*12345678Under 21 Unmarried Person #1Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #2Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #3Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #4Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #5Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #6Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #7Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Under 21 Unmarried Person #8Name(Include last name if other than family name above) Name MI Nickname Sex* Male Female Date/Birth* Month Day Year Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneBaptism* Yes No Date Baptized Month Day Year Name of Church (where baptism was administered)Denomination*CatholicProtestantJewishIslamOtherNo Affiliation/NoneChurch Location City State / Province / Region First Penance* Yes No First Communion* Yes No Catholic Confirmation* Yes No School AttendingSelect OneCatholicPublicHomeCollegeTechnicalGrade Attend Religious Education Yes No Special NeedsNoneHearing ImpairedVisually ImpairedShut-InWheelchairOther (Please explain)Please Explain Other Special Needs Is this family member a convert to the Catholic Faith?* Yes No Date of Confirmation Month Day Year Church that Administered Church Location City State / Province / Region Request The Catholic Review (Archdiocesan Newspaper) Visit by Priest Has any adult in the household been registered as a child within their parent's household? Yes No NotesCAPTCHA
