Parish Registration Form

Are you? REQUIRED New Member Updating Existing Information Please fill out this field.

Status REQUIRED Divorced Married Single Widow/Widower Please fill out this field.

If Married through the Catholic Church- Anniversary Date: Please enter a date.

Husband or Single Male First Name Please enter valid data.

Husband or Single Male Middle Name Please enter valid data.

Husband or Single Male Last Name Please enter valid data.

Wife or Single Female First Name Please enter valid data.

Wife or Single Female Middle Name Please enter valid data.

Wife or Single Female Last Name Please enter valid data.

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 Please fill out this field. Please enter a phone number.

Single Male or Husband has received the following sacraments:

Check all that apply.

Baptism Communion Confirmation

Single Male or Husband Religion Please enter valid data.

Single Male or Husband Birth Date Please enter a date.

Cell Phone Please enter a phone number.

Email Please enter an email address.

Single Female or Wife has received the following sacraments:

Check all that apply.

Baptism Communion Confirmation

Single Female or Wife Religion Please enter valid data.

Single Female or Wife Birth Date Please enter a date.

Cell Phone Please enter a phone number.

Email Please enter an email address.

In what language do you prefer to receive written communications? REQUIRED Please fill out this field.

Is there a member of your household unable to attend Mass? REQUIRED Please fill out this field.

If yes please write their name here: Please enter valid data.

Would they like a priest to visit them or someone to bring them Communion?

St. Charles Borromeo Catholic Church