Parish Registration Form – English Are you currently registered with another Parish? No Yes Parish NameWould you like an introductory meeting with the priest? Yes No Parish CityStateWould you like to enroll in online giving? Yes No Would you like to receive contribution envelopes? Yes No Do we have permission to publish the following information within the Parish? Photo Email Phone Number Address Would you like to receive the following? Parish Emails Catholic Virginian (Newspaper) Head Of HouseholdNicknameLast NameFirst NameMiddle NameTitle Mr. Mrs. Ms. Miss Dr. Other Suffix Sr. Jr. II III Other Maiden Name (if applicable)Home PhoneCell PhoneWork PhoneAddress City State Zip ReligionDate of Birth MM slash DD slash YYYY PlaceOccupationEmail AddressMarital Status Single Civil Marriage Catholic Marriage Divorced Widowed Separated Sacraments Received Baptism Communion Confirmation Select AllSacrament Parish Location(s)Race1st Language (if not English)2nd LanguageDisabilityRace and Hispanic Origin Codes: AA: American Indian and Alaska Native, A: Asian, B: Black, N: Native Hawaiian or Other Pacific Islander, T: Two or More Races, HL: Hispanic or Latino, W: White Language - S: Spanish E: English V: Vietnamese K: Korean O: Other (specify) Disability - B: Legally Blind D: Developmentally Disabled H: Hearing Impaired P: Physically Disabled S: Shut-in O: Other (specify) Spouse / Other AdultNicknameLast NameFirstMiddle NameTitle Mr. Mrs. Ms. Miss Dr. Other Suffix Sr. Jr. II III Other Maiden Name (if applicable)Home PhoneCell PhoneWork PhoneAddress City State Zip ReligionDate of Birth MM slash DD slash YYYY PlaceOccupationEmail AddressMarital Status Single Civil Marriage Catholic Marriage Divorced Widowed Separated Sacraments Received Baptism Communion Confirmation Select AllSacrament Parish Location(s)Race1st Language (if not English)2nd LanguageDisabilitySignature of the person completing the formDate MM slash DD slash YYYY Child 1 / Other AdultNicknameLast NameFirstMiddle NameTitle Mr. Mrs. Ms. Miss Dr. Other Suffix Sr. Jr. II III Other Relation to Head of Household Child Stepchild Grandchild Other GradeSchool Catholic Private Public ReligionDate of Birth MM slash DD slash YYYY PlaceSacraments Received Baptism Communion Confirmation Select AllLocation(s)Race1st Language (if not English)2nd LanguageDisabilityChild 2 / Other AdultNicknameLast NameFirstMiddle NameTitle Mr. Mrs. Ms. Miss Dr. Other Suffix Sr. Jr. II III Other Relation to Head of Household Child Stepchild Grandchild Other GradeSchool Catholic Private Public ReligionDate of Birth MM slash DD slash YYYY PlaceSacraments Received Baptism Communion Confirmation Select AllLocation(s)Race1st Language (if not English)2nd LanguageDisabilityChild 3 / Other AdultNicknameLast NameFirstMiddle NameTitle Mr. Mrs. Ms. Miss Dr. Other Suffix Sr. Jr. II III Other Relation to Head of Household Child Stepchild Grandchild Other GradeSchool Catholic Private Public ReligionDate of Birth MM slash DD slash YYYY PlaceSacraments Received Baptism Communion Confirmation Select AllLocation(s)Race1st Language (if not English)2nd LanguageDisabilityChild 4 / Other AdultNicknameLast NameFirstMiddle NameTitle Mr. Mrs. Ms. Miss Dr. Other Suffix Sr. Jr. II III Other Relation to Head of Household Child Stepchild Grandchild Other GradeSchool Catholic Private Public ReligionDate of Birth MM slash DD slash YYYY PlaceSacraments Received Baptism Communion Confirmation Select AllLocation(s)Race1st Language (if not English)2nd LanguageDisability