Saint Teresa of Avila Roman Catholic Church

1) Family Name:

2) Street address:

3) City/Town:

4) Zip code:

5) Cell Phone Number:

6) Head of Household's - First Name:

7) Head of Household's - Date of Birth:

8) Head of Household - Occupation

9) Head of Household's - Religion:

10) Head of Household's - Church Where Baptized:

11) Head of Household's - Approximate Baptismal Date:

12) Head of Household - Did you make your 1st Eucharist?

Yes

No

13) Head of Household - Have you been Confirmed?

Yes

No

14) Spouse's - First Name: (optional)

15) Spouse's - Maiden Name: (optional)

16) Spouse's - Date of Birth: (optional)

17) Spouse - Occupation (optional)

18) Spouse's - Religion: (optional)

19) Spouse's - Church Where Baptized: (optional)

20) Spouse's - Approximate Baptismal Date: (optional)

21) Sopuse - Did you make your 1st Eucharist? (optional)

Yes

No

22) Spouse - Have you been Confirmed? (optional)

Yes

No

24) If married, was this a Catholic Church Marriage? (optional)

Yes

No

25) Church location of Marriage (optional)

26) City & State (optional)

27) Date of Marriage (optional)

28) Child #1 - Name: (optional)

29) Child #1 - Date of Birth: (optional)

30) Child #1 - Current Grade (optional)

31) Child #1 - Church where Baptized (optional)

32) Child #1 - Date Baptized (optional)

33) Child #1 - Have you made your 1st Eucharist? (optional)

Yes

No

34) Child #1 - Have you made your Confirmation? (optional)

Yes

No

35) Child #2 - Name: (optional)

36) Child #2 - Date of Birth: (optional)

37) Child #2 - Current Grade (optional)

38) Child #2 - Church where Baptized (optional)

39) Child #2 - Date Baptized (optional)

40) Child #2 - Have you made your 1st Eucharist? (optional)

Yes

No

41) Child #2 - Have you made your Confirmation? (optional)

Yes

No

42) Child #3 - Name: (optional)

43) Child #3 - Date of Birth: (optional)

44) Child #3 - Current Grade (optional)

45) Child #3 - Church where Baptized (optional)

46) Child #3 - Date Baptized (optional)

47) Child #3 - Have you made your 1st Eucharist? (optional)

Yes

No

48) Child #4 - Name: (optional)

49) Child #3 - Have you made your Confirmation? (optional)

Yes

No

50) Child #4 - Date of Birth: (optional)

51) Child #4 - Current Grade (optional)

52) Child #4 - Church where Baptized

53) Child #4 - Date Baptized (optional)

54) Child #4 - Have you made your 1st Eucharist? (optional)

Yes

No

55) Child #4 - Have you made your Confirmation? (optional)

Yes

No

Saint Teresa of Avila Roman Catholic Church

New Parishioner Registration Form