Parish Registration Form Church Registering With* St. James Our Lady of the Assumption St. John the Baptist Chapel Registering as* Regular Member(s) Seasonal Member(s) Family Last Name* Primary Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code If Applicable, Seasonal Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Preferred Phone Number*Unlisted* Yes No Preferred Email Address Marital Status* Single Engaged Married Widowed Separated Divorced Number of Minors Living at Home*Please enter a number from 0 to 5.Only put children who are under 18 years of age or who have not graduated from high schoolHead of HouseholdName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Occupation* List "Student" if applicableEmployer* if student, list "school"Work PhoneCell Phone*Email (Future) SpouseName* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Birthdate*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Occupation List "Student" if applicableEmployer if student, list "school"Work PhoneCell Phone*Email Child 1First Name* add the last name if different from family name aboveSex* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of School* If not in school, put 'N/A'Grade*No GradePre-KKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthEmail Child 2First Name* add the last name if different from family name aboveSex* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of School* If not in school, put 'N/A'Grade*No GradePre-KKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthEmail Child 3First Name* add the last name if different from family name aboveSex* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of School* If not in school, put 'N/A'Grade*No GradePre-KKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthEmail Child 4First Name* add the last name if different from family name aboveSex* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of School* If not in school, put 'N/A'Grade*No GradePre-KKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthEmail Child 5First Name* add the last name if different from family name aboveSex* Male Female Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Name of School* If not in school, put 'N/A'Grade*No GradePre-KKindergartenFirstSecondThirdFourthFifthSixthSeventhEighthNinthTenthEleventhTwelfthEmail Thank you for taking the time to complete this form in its entirety. The information you provide here will assist your Parish family in providing various services/ministries to you and your family.Sacrament InformationSacrament Dates and Locations*Please follow the order of Head of Household, Spouse, and then children on separate lines. Filling in those applicableAdditional InformationPlease Indicate Reason for Parish Membership* Former Parishioner New to Area RCIA Parish Transfer Please List Former Parish* Did Your Marriage Take Place in a* Catholic Church Protestant Church Civil Ceremony Church Attendance Regular Frequent Occasional Seldom Preferred Offertory Method* Weekly Envelopes Online Giving (Note: Only those using envelopes or electronic giving will receive an annual contribution statement for tax purposes)CAPTCHA