Parish Registration

* Indicates Required Fields

Family Name *

Envelope #

Resident:

Full Time
Part Time

Street *

City *

State *

Zip *

Name of Development

Home Phone *

Street

City

State

Zip

Home Phone

Contact e-mail address

Head of Household
Name *
Date of Birth
Baptism	Yes No
First Communion	Yes No
Confirmation	Yes No
Marital Status
Married in the Catholic Church	Yes No
Occupation
Cell Phone #s
Spouse
Name
Date of Birth
Baptism
First Communion	Yes No
Confirmation	Yes No
Marital Status
Married in the Catholic Church	Yes No
Occupation
Cell Phone #s
Child 1
Name
Date of Birth
Baptism
First Communion
Confirmation
Marital Status
Married in the Catholic Church
Occupation
Cell Phone #s
+ Add another child
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We invite you to become as active in our parish as your time and talents permit. Please check as many of the following ministries/programs/organizations that may be of interest to you. There is a space at the bottom where you may place an idea.
Adult Choir Altar Servers Bible Study Boy Scouts of America Charismatic Prayer Group Council of Catholic Women Eucharistic Ministers Knights of Columbus High School Youth Group Lectors Middle School Youth Group Men’s Prayer Group Religious Education “Adult” Religious Education “Youth” R.C.I.A. Respect Life St. Vincent de Paul Society Sunday Afternoon Rosary Women of Grace Usher
Fundraising Committees:
Annual Dinner Dance Carnival
Donation Opportunities:
Church Building Fund Youth Group
“Early Childhood Ministry” If you have a child between 3 and 5 years old and you are interested in receiving more information about the program, please contact, Mrs. Betty Campestre at the church office.
Other
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Saint Therese de Lisieux