Family Last Name(s)* Wife's Maiden Name Home Phone*Work PhoneEmail* Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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
