Register as a Parishioner

Please do not auto fill - any boxes in yellow will need to be typed in singularly.

Date *

Individual's Information

Welcome to St. John the Baptist
Membership Census Card

Office Use Only

Envelope Number ________________

* Indicates required field

Last Name *

Nickname *

First Name *

Maiden Name *

Middle *

Religion *

Title *

Gender *

Suffix (Jr, Sr) *

Date of Birth *

Marital Status *

Employer *

Anniversary *

Occupation/Title *

If widowed, name of spouse *

1st Language *

Place of burial *

2nd Language *

Contact Information

Individual 1 Email *

Individual 2 Email *

Address 1 *

Address 2 *

Home Phone Number *

City *

Ind. 1 Cell Phone # *

Ind. 2 Cell Phone # *

State *

Ind. 1 Work phone # *

Ind. 2 Work Phone # *

Zip *

Emergency Contact Name *

Emergency Contact Phone *

By checking below, I give permission for my name/photo, my spouse's name/photo, my minor children's name/photo to be printed in St. John's bulletin, newsletter or website. *

My name/photo My spouse name/photo My minor children's name/photo Please do not use my name/photo

2nd Individual's Information (Spouse)

Last Name *

Nickname *

Marital Status *

First Name *

Maiden Name *

Employer *

Middle *

Religion *

Occupation/Title *

Title *

Gender *

1st Language *

Suffix (Jr, Sr) *

Date of Birth *

2nd Language *

Children Including Adult Children

Last Name/First Name/Middle *

Gender *

Date of Birth *

Place of Birth *

In Grade *

School Year *

Submit

Individual's Information

Welcome to St. John the BaptistMembership Census Card

Contact Information

2nd Individual's Information (Spouse)

Children Including Adult Children

Welcome to St. John the Baptist
Membership Census Card