Parish Registration

Family Contact Information

In this section please indicate information that is applicable to your entire household. Individual Information will be requested below.

Family Last Name

Home Phone

--

Cell Phone

Required* --

Home Address

Street 1*

Street 2

City*

State*

Zip*

Be sure to include any apartment numbers or special information that will ensure the Post Office can deliver any communications. Be sure to include Street Address, City, State, and Zip Code.

How Long Have You Been Attending Mass Here?

Required*

Previous Parish Name

Required*

Email Address

Required*

Would You Like To Receive Our Email Newsletter?
Required*

	Yes
	No

We do not send more than 2 emails per month, but think that communicating via email is an efficient way to send information to our parishioners.

Head of Household Information

If both spouses are Catholic, use this place for the husband.

Name of Head of Household

Title

First Name*

Last Name*

Gender
Required*

	Male
	Female

Birth Date

Required* //

Be sure to indicate the correct year.

Religion

Required*

Ethnicity

Required*

ex: Caucasian, African American, Hispanic, Asian, Multi-Racial

Sacramental Information (Check if Received)
Required*

	Baptism
	1st Penance
	1st Communion
	Confirmation

Employer Name & Phone Number

Current Marital Status
Required*

	Single
	Married
	Widowed
	Divorced
	Annulled
	Engaged

Wedding Date

//

Place of Wedding

City & State of Wedding

Were you married with the Blessing of the Catholic Church?

	Yes
	No

Spouse Information

If you are a single person, please scroll down to the ministry listing to complete your registration. If you are a single parent, please scroll down to the next section to insert the information for your children.

Full Name of Spouse

Title

First Name

Last Name

Gender

	Male
	Female

Birth Date

Indicate correct month, day, and year //

Religion

Ethnicity

Sacramental Information

Check all Sacraments you have received.

	Baptism
	1st Penance
	1st Communion
	Confirmation

Employer Name & Phone Number

Children's Information

	Please list the the requested information for EACH child living in your household.
First Child	Full Name, Gender, Date of Birth, Ethnicity, Religion, Sacraments Received (Baptism, Eucharist, Confirmation)
Second Child	Full Name, Gender, Date of Birth, Ethnicity, Religion, Sacraments Received (Baptism, Eucharist, Confirmation)
Third Child	Full Name, Gender, Date of Birth, Ethnicity, Religion, Sacraments Received (Baptism, Eucharist, Confirmation)
Fourth Child	Full Name, Gender, Date of Birth, Ethnicity, Religion, Sacraments Received (Baptism, Eucharist, Confirmation)

Family Interests and Activities

Please select any of the Ministries, Organizations, and Religious Educational Opportunities that you or your family members are interested in learning more about. Descriptions can be found on our website: http://www.stacharlotte.com/ministries

Spiritual Ministries

	Bereavement Ministry
	Enthronement to the Sacred Heart
	Immaculata Prayer Ministry
	Legion of Mary
	Men of Veritas

	Prayer Shawl
	RCIA
	Respect Life
	Vocations Awareness

Liturgical Ministries

Corporal Ministries

Parish Life Groups

Religious Education

Special Talents I Can Share

Why have you chosen to become a member of this parish?

Required*

Are there any special needs or circumstances of which the pastor needs to be aware?

Required*