Membership Registration Form

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

Registration Date REQUIRED Please fill out this field. Please enter a date.

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Primary Phone REQUIRED Please fill out this field. Please enter a phone number.

Primary Email REQUIRED Please fill out this field. Please enter an email address.

Marital Status Single Married in the Catholic Church Civil Marriage Widowed Separated Divorced with Annulment Divorced no Annulment

If Married: Date of Marriage Please enter valid data.

If Married: Name of Church Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

What brought you to St. Michael Catholic Church:

Head of Household

First Name REQUIRED Please fill out this field. Please enter valid data.
Middle Name REQUIRED Please fill out this field. Please enter valid data.
Last Name REQUIRED Please fill out this field. Please enter valid data.
Maiden Name (if applicable) Please enter valid data.
Gender Male Female
Date of Birth REQUIRED Please fill out this field. Please enter a date.
Occupation Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.
Cell Phone REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Name of Church of Baptism Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Spouse (if applicable)

First Name Please enter valid data.
Middle Name Please enter valid data.
Last Name Please enter valid data.
Maiden Name (if applicable) Please enter valid data.
Gender Male Female
Date of Birth Please enter a date.
Occupation Please enter valid data.
Religion REQUIRED Please fill out this field. Please enter valid data.
Cell Phone Please enter valid data.
Email Please enter an email address.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Name of Church of Baptism Please enter valid data.
City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Child 1

Child Full Name Please enter valid data.
Date of Birth Please enter a date.
Gender Male Female
Religion Please enter valid data.
Grade Please enter valid data.
School Please enter valid data.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Please list Church, City and State of Baptism Please enter valid data.

Child 2

Child Full Name Please enter valid data.
Date of Birth Please enter a date.
Gender Male Female
Religion Please enter valid data.
Grade Please enter valid data.
School Please enter valid data.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Please list Church, City and State of Baptism Please enter valid data.

Child 3

Child Full Name Please enter valid data.
Date of Birth Please enter a date.
Gender Male Female
Religion Please enter valid data.
Grade Please enter valid data.
School Please enter valid data.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Please list Church, City and State of Baptism Please enter valid data.

Child 4

Child Full Name Please enter valid data.
Date of Birth Please enter a date.
Gender Male Female
Religion Please enter valid data.
Grade Please enter valid data.
School Please enter valid data.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Please list Church, City and State of Baptism Please enter valid data.

Child 5

Child Full Name Please enter valid data.
Date of Birth Please enter a date.
Gender Male Female
Religion Please enter valid data.
Grade Please enter valid data.
School Please enter valid data.
Sacraments Received (check all that apply) Baptism First Reconciliation First Communion Confirmation
Please list Church, City and State of Baptism Please enter valid data.

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