Online Registration New Parishioner Registration Step 1 of 3 33% NameThis field is for validation purposes and should be left unchanged. HouseholdFamily Name(Required)Head of Household – First Name(Required)Last Name(Required)If different than family nameSex(Required) Male Female Date of Birth City & State of BirthFemale Head of Household – Maiden NameEmail Address(Required) Cell Phone(Required)Spouse – First NameLast NameIf different than family nameSex Male Female Date of Birth City & State of BirthFemale Spouse – Maiden NameEmail Address Cell PhoneHome Address(Required) Address Line 1 Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home/Primary Phone(Required)Primary Home Language(Required)ChildrenPlease list children, other dependents, and non relatives living in your houseNameRelationshipDate of Birth Add RemoveFirst, Middle, LastGeneral Questions (regarding the household)Household desires/needs pastoral visit? Yes No Family involved in Catholic school? Yes No Family involved in Religious Ed? Yes No Single Parent Household? Yes No All children baptized? Yes No I would like to serve within the Church in the following ways:Lector, Extraordinary Minister of Communion, Usher, Choir, Funeral Lunch Worker, Greeter, Youth Worker, Catechist. See the St. Jude website for more ministries: stjudes.netName Please ListName Please ListList in Bulletin Yes No Do you give us permission to list you and your family in the bulletin as a new parishioner?Are there children under 18 years of age?(Required) Yes No Adults over 18 years of age Adults over 18 years of ageName(Required) First Nickname Middle Last Sex Male Female ReligionActive in Faith Yes No Name of SpouseFather's NameMother's Full Maiden NameDate of Baptism(Required) Baptized as a Child? Yes No Church where BaptizedCity & State where BaptizedFirst Eucharist Yes No Reconciliation Yes No Confirmation Yes No Profession of Faith Yes No Date of Profession of Faith Marital Status Single Married Widowed Seperated Divorced Date of Marriage Married by Catholic Priest Yes No Church of MarriageCity & State of MarriageIf Divorced, When Case ever in Tribunal? Yes No Declaration of Nullity Granted Yes No Validation of Current Marriage Yes No Validation Date ChurchCity & StateEducationSpecial Needs(Physical, Developmentally Impaired/Disabled)Disabled Yes No Homebound Yes No Convert Yes No Supports Church Yes No Receives Sacraments Regularly Yes No Attends Mass Regularly Yes No Attended Catholic High School Yes No Untitled Children under 18 years of age Children under 18 years of ageName First Middle Last Relationship in Household (son, etc.)Sex Male Female ReligionActive in Faith Yes No NicknameDate of Birth City & State of BirthFather's NameMother's Full Maiden NameDate of Baptism Baptized as a child Yes No Church where BaptizedCity & State where BaptizedYear of First ReconciliationYear of First EucharistYear ConfirmedSpecial Needs(Physical, Developmentally Impaired/Disabled)School AttendingGrade LevelAttending Religious Education Yes No Untitled
