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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 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 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 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 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 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 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 ot Holy Communion (EMHC) Alter Server Sacristan Ministry of Consulation Minister to the Sick Minister of the Word/Lector Music Ministry/Choir Helping Hands Ministry (Helping homebound) St. Vincent De Paul Questions regarding Adult Sacraments Ministers of Hospitality/Usher Youth Ministry (SPY) Faith Formation Video/PPT Ministry Knights of Colombus St. Patrick Women’s Alliance (SPA) – Womens Group Prayer Shawl Hammer of St. Joseph (Mens Group) Centering Prayer Interested in becoming Catholic Date MM slash DD slash YYYY Untitled First Choice Second Choice Third Choice
