PARISHIONER REGISTRATION FORM

FAMILY LAST NAME

ENVELOPE NUMBER

MAILING NAME

FAMILY EMAIL ADDRESS

HOME PHONE #

EMERGENCY PHONE #

FULL MAILING ADDRESSES

PLEASE SELECT WHERE APPLICABLE

UBLISH ADDRESS

PUBLISH PHONE #

PUBLISH EMAIL ADDRESS

RECEIVE VISITS

RECEIVE CONTRIBUTION ENVELOPES

FIRST NAME

STATUS AT PARISH

FAMILY ROLE

NICK NAME

GENDER

DATE OF BIRTH

MIDDLE NAME

BIRTH PLACE

WORK PHONE

CELL PHONE

HIGH SCHOOL GRAD YEAR

ETHNICITY

FIRST LANGUAGE

SPECIAL NEEDS

DENOMINATION

CATHOLIC

DATE OF BAPTISM

PLACE OF BAPTISM

DATE OF FIRST COMMUNION

PLACE OF FIRST COMMUNION

New Field:

PLACE OF CATHOLIC MARRIAGE

DATE OF FIRST RECONCILIATION

PLACE OF FIRST RECONCILIATION

DATE OF CONFIRMATION

ACE OF CONFIRMATION

Free Text

FOR OTHER MEMBERS OF THE SAME HOUSEHOLD, FILL OUT JUST THE FAMILY NAME AND ENVELOPE NUMBER, THEN SUPPLY ALL THE NEEDED INFORAMTION FROM FIRST NAME, STATUS AT PARISH, FAMILY ROLE, UNTIL THE END OF THE BOXES FOR A SEPARATE SUBMISSIONS

PARISHIONER REGISTRATION FORM

Contact Us

St. Joseph Church

507 Main St, Black River Falls, WI 54615

St. Kevin Church

From The Diocese and

Around The World

PARISHIONER REGISTRATION FORM

Contact Us

St. Joseph Church

507 Main St, Black River Falls, WI 54615

St. Kevin Church

From The Diocese and

﻿Around The World

Around The World