Registration Form Registration form for all four parishes. Parish Choice(Required) St. John the Evangelist St. Joseph St. Mary Nativity St. Therese Title Mr. & Mrs. Dr. & Mrs. Mr. Mrs. Ms. Family Name Physical Address Mailing Address City/State/Zip Email Address Phone Number (Home) Phone Number (Other) Marital Status Married Single Widowed Separated Divorced Annulled Marriage InfoDate of Marriage MM slash DD slash YYYY Place of MarriageChurch City State If Other City State Are you transferring from some other parish? Yes No If yes, Church Name, City, and State Would you like to reveive a copy of the Catholic Accent? Yes No Date MM slash DD slash YYYY Head of HouseholdReligious Status Catholic Non-Catholic Last Name First Name Middle Maiden Birth Date MM slash DD slash YYYY Occupation Race Date of Baptism MM slash DD slash YYYY Church City/State Date of First Eucharist MM slash DD slash YYYY Church City/State Date of Confirmation MM slash DD slash YYYY Church City/State SpouseReligious Status Catholic Non-Catholic Last Name First Name Middle Maiden Birth Date MM slash DD slash YYYY Occupation Race Date of Baptism MM slash DD slash YYYY Church City/State Date of First Eucharist MM slash DD slash YYYY Church City/State Date of Confirmation MM slash DD slash YYYY Church City/State First Child in ResidenceReligious Status Catholic Non-Catholic Last Name First Name Middle Relationship to Head of Household Birth Date MM slash DD slash YYYY Race Sex Current Grade School Attending Date of Baptism MM slash DD slash YYYY Church City/State Date of First Eucharist MM slash DD slash YYYY Church City/State Date of Confirmation MM slash DD slash YYYY Church City/State Second Child in ResidenceReligious Status Catholic Non-Catholic Last Name First Name Middle Relationship to Head of Household Birth Date MM slash DD slash YYYY Race Sex Current Grade School Attending Date of Baptism MM slash DD slash YYYY Church City/State Date of First Eucharist MM slash DD slash YYYY Church City/State Date of Confirmation MM slash DD slash YYYY Church City/State Third Child in ResidenceLast Name First Name Middle Relationship to Head of Household Birth Date MM slash DD slash YYYY Race Sex Current Grade School Attending Date of Baptism MM slash DD slash YYYY Church City/State Date of First Eucharist MM slash DD slash YYYY Church City/State Date of Confirmation MM slash DD slash YYYY Church City/State Δ