Parish Registration

Head of Household

Name

Salutation Mr. Mrs. Ms. Dr. * Last Name * First Name * Date of Birth Religion Telephone

Address

Address Line 2

City, State, Zip

Information

Current Status Single Separated Widowed Divorced Married * Occupation Family Email Address SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Married by Priest or Deacon? Yes No

If Married, Wedding Date:

Spouse Information

Name

Salutation Mr. Mrs. Ms. Dr. Maiden Name First Name Date of Birth Religion Occupation

Information

SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Others Living With You: 21 yrs old or older

Others Living With You - 21 years old or older

Name

Salutation Mr. Mrs. Ms. Dr. Last Name First Name Date of Birth Religion Occupation Relationship to Household

Information

SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Others Living With You: 21 yrs old or older

Others Living With You - 21 years old or older

Name

Salutation Mr. Mrs. Ms. Dr. Last Name First Name Date of Birth Religion Occupation Relationship to Household

Information

SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Child 1 Living With You: Under 21 yrs old

Child 1 Living With You - under 21 yrs old

Name

Last Name First Name Date of Birth Religion Relationship to Household

Information

School Grade SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Child 2 Living With You: Under 21 yrs old

Child 2 Living With You - under 21 yrs old

Name

Last Name First Name Date of Birth Religion Relationship to Household

Information

School Grade SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Child 3 Living With You: Under 21 yrs old

Child 3 Living With You - under 21 yrs old

Name

Last Name First Name Date of Birth Religion Relationship to Household

Information

School Grade SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Child 4 Living With You: Under 21 yrs old

Child 4 Living With You - under 21 yrs old

Name

Last Name First Name Date of Birth Religion Relationship to Household

Information

School Grade SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Child 5 Living With You: Under 21 yrs old

Child 5 Living With You - under 21 yrs old

Name

Last Name First Name Date of Birth Religion Relationship to Household

Information

School Grade SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Child 6 Living With You: Under 21 yrs old

Child 6 Living With You - under 21 yrs old

Name

Last Name First Name Date of Birth Religion Relationship to Household

Information

School Grade SMPS Graduate? Yes No Year

Sacramental History

Baptism Yes No

First Communion Yes No

Confirmation Yes No

Security Code

Thank you for submitting a membership registration with St. Michael Parish. We will contact you shortly with confirmation and details for your membership.

We are happy to have you as part of our community!

St. Michael's Parish