Parish Registration Form

We welcome you to Saint Jerome Catholic Parish and invite you to register for the parish!

Would you like to register in our parish? Please stop by or call the Parish office. You may download your registration form and mail it to us, or complete the online form below. (Quisiera registrarse en la Parroquia?  Form de Registro Parroquial)

I Am*
 Registering As A New Parishioner Already Registered, But Need To Update My Information

Family Information

Address*

Phone Number*

Phone Number 2

Email*

Email 2

Giving Options
 I Want to Receive Envelopes I Want To Sign Up for Auto-Deduction from My Bank Account

*Thank you for choosing EFT. Someone will be contacting you in order to give you further instructions to set this up.

Head of House
Information for the Head of Household (or individual if you are single)

Household Title*
—Mr.Mrs.Ms.

Full Name*

Gender*
 Male Female

Birth Date*

Religion*

Occupation*

Languages Spoken*

Sacraments Received* (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Marital Status*
—MarriedSingleSeparatedDivorcedWidowed

Spouse/Other Adult
If no other adult, skip this section.

Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received* (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Children (Living at Home)
If no children, skip this section.

Child #1 Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Child #2 Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Child #3 Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Child #4 Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Child #5 Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

Child #6 Full Name

Gender
 Male Female

Birth Date

Religion

Occupation

Languages Spoken

Sacraments Received (Check all that apply)
 None Baptism First Reconciliation First Eucharist Confirmation

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