Dependent Currently Living in Household

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Parish Membership

First Name *

Middle Name *

Last Name *

Gender *

• Male
• Female

Preferred Name

Date of Birth *

Cell Phone

Primary Email Address *

Name of School

Grade *

- Select -3yr old4yr oldKindergarten1st2nd3rd4th5th6th7th8th9th10th11th12th

Active Catholic

• Yes
• No

If no, list religion

Baptism

Date of Baptism

Name of Parish

Location

City, State

Reconciliation

Date of First Reconciliation

Name of Parish

Location

Communion

Date of Communion

Name of Parish

Location

Confirmation

Date of Confirmation

Name of Parish

Location

Validate Email