Mr. Miss Ms. Mrs. Last name: First name: Date: Street Address: City: Zip Code: Telephone#1: Telephone #2: *E-mail: * Required for e-mailing form Occupation: Your birth date: Your marital status (Click on one.): Church Marriage Married Single Widowed Divorced If married, date of marriage: Sacraments (Click on all that apply.): You are baptized You are NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Confirmed NOT confirmed Family members: Spouse Last name: First name: Gender: M F Occupation: Spouse birth date: Sacraments completed (Click on all that apply.): Spouse baptized Spouse NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Confirmed NOT confirmed
Children living with you: Child #1 Last name: First name: Gender: M F Date of Birth: Sacraments completed (Click on all that apply.): Child 1 baptized Child 1 NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Child 1 Confirmed Child 1 NOT confirmed Child #2 Last name: First name: Gender: M F Date of Birth: Sacraments completed (Click on all that apply.): Child 2 baptized Child 2 NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Child 2 Confirmed Child 2 NOT confirmed Child #3 Last name: First name: Gender: M F Date of Birth: Sacraments completed (Click on all that apply.): Child 3 baptized Child 3 NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Child 3 Confirmed Child 3 NOT confirmed Child #4 Last name: First name: Gender: M F Date of Birth: Sacraments completed (Click on all that apply.): Child 4 baptized Child 4 NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Child 4 Confirmed Child 4 NOT confirmed Child #5 Last name: First name: Gender: M F Date of Birth: Sacraments completed (Click on all that apply.): Child 5 baptized Child 5 NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Child 5 Confirmed Child 5 NOT confirmed Child #6 Last name: First name: Gender: M F Date of Birth: Sacraments completed (Click on all that apply.): Child 6 baptized Child 6 NOT baptized 1st Communion completed NOT made 1st Communion 1st Reconciliation completed NOT made 1st Reconciliation Child 6 Confirmed Child 6 NOT confirmed Questions, comments:
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