Online Registration

Family Contact Info

Family Last Name REQUIRED Please fill out this field. Please enter valid data.
Street 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.
Mailing 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.
Preferred Email Please enter valid data.
Preferred Contact Phone Number Maximum 20 characters Please enter a phone number.
Preferred Language (English/Spanish) REQUIRED English Espanol Bilingual, prefer English Bilingual, prefer Spanish Please fill out this field.
Would you like for St. Patrick to be your primary parish? REQUIRED We are already registered as members at St. Patrick. Yes, we'd like to be members at St. Patrick. No, we prefer to keep another parish as our home parish. Yes, please order church envelopes. No church envelopes. Please fill out this field.

Parent(s) / Head(s) of Household

Marital Status/Estado civil Single Engaged Married in the Catholic Church Married outside the Catholic Church (civil, common law, Protestant ceremony, or non-Christian faith) Widowed Divorced Other

Self

Spouse (or other adult in the home)

First Name Please enter valid data.

Last Name Please enter valid data.
Gender/ Género Male Female
Date of birth Please enter a date.
Religion Please enter valid data.
Sacraments Received Baptism (Catholic) Baptism (other faith) Reconciliation First Eucharist Confirmation Marriage in the Catholic Church Ordination (Deacon)
Occupation/Employer Ocupación Please enter valid data.
Work Phone Number Maximum 20 characters Please enter a phone number.
Cell Phone Number Maximum 20 characters Please enter a phone number.
Preferred Phone Number

Child #1

Child #2

Child #3

Child #4

Child #5

Child #6

Are there any homebound/disabled in the home? Please list their name(s).