Parish Registration Form CAPTCHAMembership InformationIn this section we collect information about membership and envelopesAre you a new parishioner?(Required) Yes No Are you updating information?(Required) Yes No Do you currently receive envelopes from us? Yes No Do you want to receive envelopes or would you prefer information about online giving?(Required) Yes, I want envelopes No, I want information about online giving Would you like to receive Flocknotes? (Email & Text notifications about church related events)(Required) Yes, I would like Flocknotes No, I do not want Flocknotes Which Parish are you trying to join?(Required) Holy Spirit, Winfield St. Helen, Hebron St. Mary, Kouts Contact InformationIn this section we collect information on how to contact youName(Required) First Last Address(Required) Street Address Address Line 2 City 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 State ZIP Code Date of Birth(Required) Month Day Year Marital Status(Required)Choose OneSingleEngagedMarried CivillyMarried in Catholic ChurchDivorcedWidowedEmail(Required) Phone(Required)Preferred LanguageReligionSpouse Name(Required) First Last Spouse Date of Birth(Required) Month Day Year Are you interested in volunteering in a Parish Ministry?(Required) Yes No Maybe Do you have children and/or other adults living at home with you(Required)Children would be classified as those 18 years old or younger Yes, Children Yes, Other Adults Yes, Both No, Neither Number of Children Living at Home(Required)Child #1 InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender(Required) Male Female This child has received the following Sacraments Baptism First Holy Communion Confirmation Child #2 InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender(Required) Male Female This child has received the following Sacraments Baptism First Holy Communion Confirmation Child #3 InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender(Required) Male Female This child has received the following Sacraments Baptism First Holy Communion Confirmation Child #4 InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender(Required) Male Female This child has received the following Sacraments Baptism First Holy Communion Confirmation Child #5 InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender(Required) Male Female This child has received the following Sacraments Baptism First Holy Communion Confirmation Child #6 InformationName(Required) First Last Date of Birth(Required) Month Day Year Gender(Required) Male Female This child has received the following Sacraments Baptism First Holy Communion Confirmation Other Adults Living in The HomeIn this section we collect information about other adults who live in your homeOther Adults Living In Home Information(Required)NameRelationshipDate of Birth (mm/dd/yyyy) Add RemoveClick the plus button on the right side to add another row to input information for additional entriesSacramentsIn this section, let us know if anyone in your home needs to receive any Sacraments, including Marriage, Convalidation, RCIA, Baptism, First Holy Communion and Confirmation.Does anyone in your household need to receive a Sacrament? Yes No Not Sure If "not sure", please explain. If "yes" let us know which Sacrament(s).Additional InformationAdditional Information or CommentsUntitled First Choice Second Choice Third Choice Untitled First Choice Second Choice Third Choice Untitled First Choice Second Choice Third Choice PhoneThis field is for validation purposes and should be left unchanged.
