St. Rose of Lima Registration Page

St Rose of Lima Registration Form

- Step 1 of 14

Date / Time

Registration - New Member Or Change In Membership Information

New Member
Change In Membership Information

How long have you been attending St. Rose?

Office Use Only

Registration
Welcome
Contact

Envelope #

Family Last Name

Home Phone

Languages

Address

Address Line 1

Address Line 2

City

State

Zip Code

Self: Personal Email

Self: Employer Email

Self: Work Phone

Self: Ethnicity (optional)

Spouse: Personal Email

Spouse: Employer Email

Spouse: Work Phone

Spouse: Ethnicity (optional)

Wedding Anniversary Date

Correspondence Addressed To - Preferred Titles

Do you know how you might like to volunteer at St. Rose?

Have you received St. Rose's Welcome Packet?

For weekly contributions, would like to participate in online giving or use envelopes?

Online Giving
Envelopes
Third Choice

Would you like to receive the weekly bulletin via email?

If Yes, by which email would you prefer it to be sent?

Self - Full Name

Self - Nickname

Self - Gender

Male
Female

Self - Do you live at home?

Self - Birth Date (mm/dd/yy)

Self - Marital Status (S,M,W,D)

Self - Religion

Self - Occupation/School Grade

Self - Cell Phone

Spouse - Full Name

Spouse - Nickname

Spouse - Gender

Male
Female

Spouse - Do you live at home?

Spouse - Birth Date (mm/dd/yy)

Spouse - Marital Status (S,M,W,D)

Spouse - Religion

Spouse - Occupation/School Grade

Spouse - Cell Phone

Child 1 - Full Name

Child 1 - Spouse Nickname

Child 1 - Spouse Gender

Male
Female

Child 1 - Do you live at home?

Child - Birth Date (mm/dd/yy)

Child 1 - Marital Status (S,M,W,D) (copy)

Child 1 - Religion

Child 1 - Occupation/School Grade

Child 1 - Cell Phone

Child 2 - Full Name

Child 2 - Nickname

Child 2 - Gender

Male
Female

Child 2 - Do you live at home?

Child 2 - Birth Date (mm/dd/yy)

Child 2 - Marital Status (S,M,W,D)

Child 2 - Religion

Child 2 - Occupation/School Grade

Child 2 - Cell Phone

Child 3 - Full Name

Child 3 - Nickname

Child 3 - Gender

Male
Female

Child 3 - Do you live at home?

Child 3 - Birth Date (mm/dd/yy)

Child 3 - Marital Status (S,M,W,D)

Child 3 - Religion

Have you received St. Rose's Welcome Packet?

Child 3 - Occupation/School Grade

Child 3 - Cell Phone

Child 4 - Full Name

Child 4 - Nickname

Child 4 - Gender

Male
Female

Child 4 - Do you live at home?

Child 4 - Birth Date (mm/dd/yy)

Child 4 - Marital Status (S,M,W,D)

Child 4 - Religion

Child 4 - Occupation/School Grade

Child 4 - Cell Phone

Self - Name (include maiden name) - SACRAMENTAL INFORMATION - If not sure of the date or location, simply type in Yes. - Leave the space blank, if the sacrament has not been celebrated.

Self - Baptismal Date

Self - Baptismal Parish & Location

Self - 1st Penance Date

Self - 1st Penance Parish & Location

Self - 1st Eucharist Date

Self - 1st Eucharist Parish & Location

Self - Confirmation Date

Self - Confirmation Parish & Location

Self - Marriage Date

Self - Mariage Parish & Location

Spouse Name - (include maiden name) - SACRAMENTAL INFORMATION - If not sure of the date or location, simply type in Yes. - Leave the space blank if the sacrament has not been celebrated.

Spouse - Baptism Date

Spouse - Baptism Parish & Location

Spouse - 1st Penance Date

Spouse - 1st Penance Parish & Location

Spouse - 1st Eucharist Date

Spouse - 1st Eucharist Parish & Location

Spouse - Confirmation Date

Spouse - Confirmation Parish & Location

Spouse - Marriage Date

Spouse - Marriage Parish & Location

Child 1 Name - (include maiden name) - SACRAMENTAL INFORMATION - If not sure of the date or location, simply type in Yes. - Leave the space blank if the sacrament has not been celebrated.

Child 1 - Baptism Date

Child 1 - Baptism Parish & Location

Child 1 - 1st Penance Date

Child 1 - 1st Penance Location

Child 1 - 1st Eucharist Date

Child 1 - 1st Eucharist Parish & Location

Child 1 - Confirmation Date

Child 1 - Confirmation Location

Child 1 - Marriage Date

Child 1 - Marriage Parish & Location

Child 2 Name - (include maiden name) - SACRAMENTAL INFORMATION - If not sure of the date or location, simply type in Yes. - Leave the space blank if the sacrament has not been celebrated.

Child 2 - Baptismal Date

Child 2 - Baptismal Parish & Location

Child 2 - 1st Penance Date

Child 2 - 1st Penance Parish & Location

Child 2 - 1st Eucharist Date

Child 2 - 1st Eucharist Parish & Location

Child 2 - Confirmation Date

Child 2 - Confirmation Parish & Location

Child 2 - Marriage Date

Child 2 - Marriage Parish & Location

Child 3 Name - (include maiden name) - SACRAMENTAL INFORMATION - If not sure of the date or location, simply type in Yes. - Leave the space blank if the sacrament has not been celebrated.

Child 3 - Baptism Date

Child 3 - Baptism Parish & Location

Child 3 - 1st Penance Date

Child 3 - 1st Penance Parish & Location

Child 3 - 1st Eucharist Date

Child 3 - 1st Eucharist Parish & Location

Child 3 - Confirmation Date

Child 3 - Confirmation Parish & Location

Child 3 - Marriage Date

Child 3 - Marriage Parish & Location

Child 4 Name - (include maiden name) - SACRAMENTAL INFORMATION - If not sure of the date or location, simply type in Yes. - Leave the space blank if the sacrament has not been celebrated.

Child 4 - Baptism Date

Child 4 - Baptism Parish & Location

Child 4 - 1st Penance Date

Child 4 - 1st Penance Parish & Location

Child 4 - 1st Eucharist Date

Child 4 - 1st Eucharist Parish & Location

Child 4 - Confirmation Date

Child 4 - Confirmation Parish & Location

Child 4 - Marriage Date

Child 4 - Marriage Parish & Location

Please note anything else that you think would be helpful to our parish. Thanks for completing this registration!

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