St. Francis of assisi
catholic church
Check this box if you want your e-mail address published in the parish directory.
—Online Registration Form—
Local Address
Street Address:
City:
State:
Zip:
Mailing  Address (if different):
City:
State:
Zip:
Primary Phone:
Second Residence
Address:
City:
State:
Zip:
Phone:
Dates at 2nd Residence:
From:
To:
Send mail to 2nd Residence during this time?
►Family Member to notify in emergency:
Your Name:
Marital Status:
Religion:
Gender:
Date of Birth:
Occupation:
Business Location:
Business Phone:
Baptism:
Location:
1st Comm:
Location:
Penance:
Location:
Confirmed:
Location:
Marriage:
Location:
Spouse’s Name:
Marital Status:
Religion:
Gender:
Date of Birth:
Occupation:
Business Location:
Business Phone:
Sacraments  (for above member)
FOR OFFICE USE ONLY ID/ENV: ________________ ENTERED BY: __________
Family Name:
Baptism:
Location:
1st Comm:
Location:
Penance:
Location:
Confirmed:
Location:
Marriage:
Location:
Sacraments  (for above member)
E-mail Address (for official Church information only):
If you have recently joined our parish, from where did you move?
City, State:
Parish:
(The parish office will not divulge e-mail addresses unless permission has been checked.)
How many people are in your household?
All Catholic?