Register as a Parishioner

Family Name
Individual's Name
Last Name First Name Middle
Title (Mr., Mrs., Ms.) Nickname Suffix (Jr., Sr.)
Maiden Name
Contact and Phone Numbers (indicate if unlisted)
Home Cellular
Work Ext. Fax
Email
Personal Information
Gender  M F Date of Birth Marital Status  Married Single Widowed
Religion Age Anniversary
Language 1st Language 2nd
Employer Occupation/Title
Individual's Name (or Spouse)
Last Name First Name Middle
Title (Mr., Mrs., Ms.) Nickname Suffix (Jr., Sr.)
Maiden Name
Contact and Phone Numbers (indicate if unlisted)
Home Cellular
Work Ext. Fax
Email
Personal Information
Gender  M F Date of Birth Marital Status  Married Single Widowed
Religion Age Anniversary
Language 1st Language 2nd
Employer Occupation/Title
Address 1
Address City State Zip
Address City State Zip
If Married
Name of Church / City of Marriage
If Widowed
Spouse's Name Place of Burial
Children (Please list all adult children also.)
Name (last, first, middle) Gender Date of Birth Place of Birth For children living at home
List School Attending / Grade
 M F In Grade the school year
 M F In Grade the school year
 M F In Grade the school year
 M F In Grade the school year
 M F In Grade the school year
 M F In Grade the school year
 M F In Grade the school year
 M F In Grade the school year
Emergency Contact
Name Phone Number
I give my permission for
MY name or photo  Yes No
MY SPOUSE'S name or photo  Yes No
MY MINOR CHILDREN'S name or photo  Yes No
to be printed in St. John's bulletin, newsletter or website
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