Parish Registration Form

Today's Date Please enter valid data.

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Home Phone Number Please enter valid data.

Home Address Please enter valid data.

City Please enter valid data.

State

Zip Please enter a zip code.

Marital Status REQUIRED Please fill out this field.

***IF YOU ARE NOT MARRIED, ONLY FILL OUT SPACES THAT APPLY TO YOU.

Male's First & Middle Name Please enter valid data.

Birth Date (mmm/dd/yyyy) Please enter valid data.

Religion REQUIRED Catholic Non-Catholic Please fill out this field.

Sacraments Received Baptism First Penance First Holy Communion Confirmation Matrimony None

Name of Catholic Church where Married, and date of marriage Please enter valid data.

E-mail address (male) Please enter valid data.

Cell Phone Number (male) Please enter a phone number.

Female's First & Middle Name Please enter valid data.

Maiden Name Please enter valid data.

Birth Date (mmm/dd/yyyy) Please enter valid data.

Religion REQUIRED Catholic Non-Catholic Please fill out this field.

Sacraments Received Baptism First Penance First Holy Communion Confirmation Matrimony None

Phone Number REQUIRED Home Cell Please fill out this field.

Cell Phone Number (female) Please enter a phone number.

E-mail address (female) Please enter valid data.

Mailing Address (if different from above) Please enter valid data.

Primary Mass attending REQUIRED 5:00 PM Saturday 8:00 AM Sunday 10:30 AM Sunday Please fill out this field.

Tithing Option REQUIRED Request Envelopes Online Giving Please fill out this field.

Dependent Child #1

Dependent Child #2

Dependent Child #3

Dependent Child #4

Dependent Child #5

Dependent Child #6

Dependent Child #7

Dependent Child #8

Is there anything else you would like for us to know about your family? (Special Needs, Shut-In, etc.) Please enter valid data.

Other: Please enter valid data.

St. Anne Catholic Church