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Important: Delete this tip before you publish the form.Household InformationYour Address Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Individual Member InformationIndividual 1Individual 1(Required) First Middle Last Your Email Address Email Address Confirm Email Address Your PhoneMarital StatusSingleMarried (Catholic)Married non-CatholicWidowedSeparatedDivorcedReligionCatholicBaptised ChristianOtherPrimary Ethnicity/Racial IdentificationWhite/CaucasianBlack/African AmericanFilipinoNative AmericanAsian/IndianOtherDate of Birth MM slash DD slash YYYY Gender Male Female Primary Language English Spanish Other SacramentsFirst Reconciliation Yes No Baptised (Catholic) Yes No First Eucharist Yes No Confirmed Yes No Would you like to receive Envelopes? Yes No Individual 2Individual 2 First Middle Last Relationship to Individual 1SpouseChildGrandchildParentOtherYour Email Address Email Address Confirm Email Address Your PhoneMarital StatusSingleMarried (Catholic)Married non-CatholicWidowedSeparatedDivorcedReligionCatholicBaptised ChristianOtherPrimary Ethnicity/Racial IdentificationWhite/CaucasianHispanic/Latino/SpanishBlack/African AmericanFilipinoNative AmericanAsian/IndianOtherDate of Birth MM slash DD slash YYYY Gender Male Female Primary Language English Spanish Other SacramentsBaptised (Catholic) Yes No First Reconciliation Yes No Confirmed Yes No First Eucharist Yes No Individual 3Individual 3 First Middle Last Relationship to Individual 1SpouseChildGrandchildParentOtherMarital StatusSingleMarried (Catholic)Married non-CatholicWidowedSeparatedDivorcedReligionCatholicBaptised ChristianOtherPrimary Ethnicity/Racial IdentificationWhite/CaucasianHispanic/Latino/SpanishBlack/African AmericanFilipinoNative AmericanAsian/IndianOtherDate of Birth MM slash DD slash YYYY Gender Male Female Primary Language English Spanish Other SacramentsBaptised (Catholic) Yes No First Reconciliation Yes No Confirmed Yes No First Eucharist Yes No Individual 4Individual 4 First Middle Last Relationship to Individual 1SpouseChildGrandchildParentOtherMarital StatusSingleMarried (Catholic)Married non-CatholicWidowedSeparatedDivorcedReligionCatholicBaptised ChristianOtherPrimary Ethnicity/Racial IdentificationWhite/CaucasianHispanic/Latino/SpanishBlack/African AmericanFilipinoNative AmericanAsian/IndianOtherDate of Birth MM slash DD slash YYYY Gender Male Female Primary Language English Spanish Other SacramentsBaptised (Catholic) Yes No First Reconciliation Yes No Confirmed Yes No First Eucharist Yes No Individual 5Individual 5 First Middle Last Relationship to Individual 1SpouseChildGrandchildParentOtherMarital StatusSingleMarried (Catholic)Married non-CatholicWidowedSeparatedDivorcedReligionCatholicBaptised ChristianOtherPrimary Ethnicity/Racial IdentificationWhite/CaucasianHispanic/Latino/SpanishBlack/African AmericanFilipinoNative AmericanAsian/IndianOtherDate of Birth MM slash DD slash YYYY Gender Male Female Primary Language English Spanish Other SacramentsBaptised (Catholic) Yes No First Reconciliation Yes No Confirmed Yes No First Eucharist Yes No Individual 6Individual 6 First Middle Last Relationship to Individual 1SpouseChildGrandchildParentOtherMarital StatusSingleMarried (Catholic)Married non-CatholicWidowedSeparatedDivorcedReligionCatholicBaptised ChristianOtherPrimary Ethnicity/Racial IdentificationWhite/CaucasianHispanic/Latino/SpanishBlack/African AmericanFilipinoNative AmericanAsian/IndianOtherDate of Birth MM slash DD slash YYYY Gender Male Female Primary Language English Spanish Other SacramentsBaptised (Catholic) Yes No First Reconciliation Yes No Confirmed Yes No First Eucharist Yes No Comments/RequestsCheck any Ministry you would like more information about Extraordinary Minister of Holy Communion (EMHC) Altar Server Sacristan Ministry of Consulation Minister to the Sick Lector/Minister of the Word Music Ministry/Choir Helping Hands Ministry (Helping homebound) St. Vincent De Paul Adult Sacraments information Thank you for your interest in our Ministries. Your information will be passed on to a Ministry leader to contact you. Ministers of Hospitality/Usher Youth Ministry (SPY) Faith Formation Video/PPT Ministry Knights of Columbus St. Patrick Alliance of Women (SPA) – Women’s Group Prayer Shawl Hammer of St. Joseph (Men’s Group) Centering Prayer Interested in becoming Catholic Date MM slash DD slash YYYY
