Parishioner Registration Form

Registration

List (Dropdown)	Are you...... *

Family Information

Date

Required* //

Family Last Name

Required*

Family Phone

List the main number for contact* --

Main email for contact

Home Address

Street 1*

Street 2

City*

State*

Zip*

Mailing Address

Street 1

Street 2

City

State

Zip

If different from home address

Head of Household

When filling out this information, much of the information is a required field. We use this information for identification for sacramental purposes.

Title

Required*

Full Legal Name

First Name*

Middle Name

Last Name*

As on Birth Certificate

Suffix

Nickname

E-mail

Cell Phone

Work Phone

-- ext

Occupation

Date of Birth

Required* //

Place of Birth

City and State*

Ethnicity

Religion

Required*

Sacraments Received
Required*

Check ALL that apply*

	Baptism
	Eucharist
	Confirmation

	Matrimony
	None Received

Marital Status

Required*

Maiden Name

Church Marriage Date

If married in the Catholic Church or your marriage is recognized by the Catholic Church

Civil Marriage Date

If no spouse or dependants scroll down to the Ministries Section.

Spouse

We use this information for identification for sacramental purposes. Please fill out as much as possible.

Title

Full Legal Name

First Name

Middle Name

Last Name

As on Birth Certificate or Marriage License

Suffix

Nickname

E-mail

Cell Phone

Work Phone

-- ext

Occupation

Date of Birth

Place of Birth

City and State

Religion

Sacraments Received

Check ALL that apply

	Baptism
	Eucharist
	Confirmation

	Marriage
	None Received

Marital Status

Maiden Name

Ethnicity

Dependants

A dependant is a child/grandchild under the age of 18 living in your household. However, this can also be a family member such as a parent in your household under your care. If your children are over 18, whether living with you or on their own, they should register as a separate family.
If no dependants skip to the bottom to the Ministries section.

Dependant #1

We use this information for identification for sacramental purposes. Please fill out as much as possible.

Title

Full Legal Name

First Name

Middle Name

Last Name

As on Birth Certificate

Suffix

Nickname

Relationship to Head of Household

E-mail

Cell Phone

Date of Birth

Place of Birth

City and State

Maiden Name

Birth Father's Legal Name

First Name

Middle Name

Last Name

Birth Mother's Legal Name (Maiden)

First Name

Middle Name

Last Name

Religion

Sacraments Received

Check ALL that apply

	Baptism
	Eucharist
	Confirmation

	Matrimony
	None Received

Ethnicity

Dependant #2

We use this information for identification for sacramental purposes. Please fill out as much as possible.

Full Legal Name

First Name

Middle Name

Last Name

As on Birth Certificate

Suffix

Nickname

Relationship to Head of Household

E-mail

Cell Phone

Date of Birth

Place of Birth

City and State

Maiden Name

Birth Father's Legal Name

First Name

Middle Name

Last Name

Birth Mother's Legal Name (Maiden)

First Name

Middle Name

Last Name

Religion

Sacraments Received

Check ALL that apply

	Baptism
	Eucharist
	Confirmation

	Matrimony
	None Received

Ethnicity

Dependant #3

We use this information for identification for sacramental purposes. Please fill out as much as possible.

Full Legal Name

First Name

Middle Name

Last Name

As on Birth Certificate

Suffix

Nickname

Relationship to Head of Household

E-mail

Cell Phone

Date of Birth

Place of Birth

City and State

Maiden Name

Birth Father's Legal Name

First Name

Middle Name

Last Name

Birth Mother's Legal Name (Maiden)

First Name

Middle Name

Last Name

Religion

Sacraments Received

Check ALL that Apply

	Baptism
	Eucharist
	Confirmation

	Matrimony
	None Received

Ethnicity

Dependant #4

We use this information for identification for sacramental purposes. Please fill out as much as possible.

Full Legal Name

First Name

Middle Name

Last Name

As on Birth Certificate

Suffix

Nickname

Relationship to Head of Household

E-mail

Cell Phone

Date of Birth

Place of Birth

City and State

Maiden Name

Birth Father's Legal Name

First Name

Middle Name

Last Name

Birth Mother's Legal Name (Maiden)

First Name

Middle Name

Last Name

Religion

Sacraments Received

Check ALL that Apply

	Baptism
	Eucharist
	Confirmation

	Matrimony
	None Received

Ethnicity

Dependant #5

We use this information for identification for sacramental purposes. Please fill out as much as possible.

Full Legal Name

First Name

Middle Name

Last Name

As on Birth Certificate

Suffix

Nickname

Relationship to Head of Household

E-mail

Cell Phone

Date of Birth

Place of Birth

City and State

Maiden Name

Father's Legal Name

First Name

Middle Name

Last Name

Mother's Legal Name (Maiden)

First Name

Last Name

Religion

Sacraments Received

	Baptism
	Eucharist
	Confirmation

	Matrimony
	None Received

Ethnicity

Ministries

Our parish offers a wide variety of ministries all of your spiritual needs. Choose the ministries you and/or your family are interested in participating in.

Ministries
Required*

Select as many ministries as you would like

Electronic Signature

I understand that by becoming a member of the St. Patrick Community, I am called to: (1) Attend Mass Regularly at this parish. (2) Use my Sunday collection envelopes or contribute Online. (3) Support the Ministries of my parish.

Electronic Signature

First Name*

Middle Name

Last Name*

Online Giving

If you would like more information on Online Giving, please click on the Online Giving Icon at the bottom of the home page or the Online Giving Tab at the top of this page. If you have any questions about Online Giving that cannot be answered on this website, please feel free to call the office at 361-855-7351.

Submitting this Form

This form will not be sent to the office unless you click on the SUBMIT button at the bottom of this page.