1. Today's Date

MM

DD

YYYY

2. Name of Main Contact *

First Name

Last Name

4. Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

5. Phone

(###)

###

####

6. Date of Birth of Main Contact

MM

DD

YYYY

7. Is the Main Contact Person Catholic?

Yes

No

8. If Yes, that the main contact person is Catholic, what Sacraments have you received?

Catholic Baptism

Profession of Faith (Means you were baptized another religion and officially became Catholic)

First Holy Communion

Confirmation

10. Marital Status:

Married

Separated

Single

Widowed

Divorced

11. If married, were you married in the Catholic Church?

Yes

No

12. If married, what is the date of marriage?

MM

DD

YYYY

13. Name of Spouse (if married)

First Name

Last Name

14. Spouse's Date of Birth

MM

DD

YYYY

16. Phone

(###)

###

####

17. Is spouse Catholic?

Yes

No

18. If yes, which Sacraments have they received?

Catholic Baptism

Profession of Faith

First Holy Communion

Confirmation

19. #1 Name of Child or dependent living at home:

First Name

Last Name

20. Date of Birth

MM

DD

YYYY

21. Gender of Child

Male

Female

22. Please check the sacraments #1 Child has received

Catholic Baptism

First Communion

Confirmation

23. #2 Name of Child or dependent living at home:

First Name

Last Name

24. Date of Birth

MM

DD

YYYY

25. Gender of Child

Male

Female

26. Please check the sacraments #2 Child has received:

Catholic Baptism

First Communion

Confirmation

27. #3 Name of Child or dependent living at home:

First Name

Last Name

28. Date

MM

DD

YYYY

29. Gender of Child

Male

Female

30. Please check the sacraments #3 child has received:

Catholic Baptism

First Communion

Confirmation

31. Opportunities of Interests:

Please check ministries that you might want more information about.

Greeter at Mass

Lector at Mass

Extraordinary Minister of Communion at Mass

Altar Serving at Mass

Home Visting

Knights of Columbus

Marthas & Marys (womens group of OLR)

Choir

Adult Education

Children's Faith Formation (pre school - 5th grade)

iGnite Youth Ministry (6th -12th grade)

Returning Catholics Program

St. Vincent de Paul

Prayer Chain

Hospitality Ministry

Grief Share Ministry

Divorce Care Ministry

Adorers of The Blessed Sacrament

32. We want to receive:

Idaho Catholic Register Newspaper

Contribution Envelopes

Neither at this time