Parish Registration Form

Family Member REQUIRED

Submit for each family member

Adult Child Other Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Middle Name or Initial Please enter valid data.

Nickname Please enter valid data.

Title (Mr./Mrs./Ms./Dr.) Please enter valid data.

Maiden Name Please enter valid data.

Gender REQUIRED Male Female Please fill out this field.

Marital Status REQUIRED Married by a Priest Married by Minister Married by a Judge or JP Widow/Widower Single Divorced Separated Please fill out this field.

Date of Marriage Please enter valid data.

Religion Please enter valid data.

Birthdate Please enter valid data.

Date Baptized Please enter valid data.

Church of Baptism, City, State Please enter valid data.

First Communion Yes No

Confirmed Yes No

Languages Spoken Please enter valid data.

Occupation Please enter valid data.

Business Phone Please enter valid data.

Cell/Beeper/Fax Please enter valid data.

E-Mail Address Please enter valid data.

School Attending Please enter valid data.

Highest Grade/Degree Please enter valid data.

Handicap (if any) Please enter valid data.

Shut-in Yes No

Ministries or Church Groups Please enter valid data.

Skills Please enter valid data.

Special Interest/Hobbies Please enter valid data.

St. Thomas the Apostle

Long Beach, MS

Parish Registration Form