SAINT AGNES PARISH REGISTRATION
Please print and fill out this form and return to the Parish Office
ID#___________
Family Last Name:
______________________________Date: ____________________
Marital Status: (circle one) Married Single
Separated Divorced Widow(er)
If married, was it celebrated as a Sacrament in the
Catholic Church? Yes ( ) No
( )
If a family member is homebound, would they like to receive the Holy Eucharist weekly Yes ( ) No ( )
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First Name & Middle
Initial (Last if different from
above) |
Religion |
Male(M) or Female(F) |
Date of Birth |
Date of Baptism |
Date of Eucharist |
Date of Confirm |
School Name |
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Head of Household |
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Spouse |
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Child |
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Child |
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Child |
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Other adult living in Household |
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