Author: cfiore

St. Mary Catholic Church
New Parishioner Registration Form

Family Name:___________________________________________
Street Address:__________________________________________
City:__________________________ State:_____ Zip:___________

Would you like to sign-up for our Friday email newsletter about what is going on at St. Mary Church? Yes___ No___
Would you like our Pastor to contact you? Yes___ No___

Why did you select St. Mary’s as your new parish?________________________________________________________________________
I would like to learn more about the following ministries (Circle all that apply):
Liturgy (Lector, Eucharistic Minister, Altar Server, Usher, Church Cleaning, Linen Cleaning)
Music (Adult/Children’s Choir, Instrumentalist)
Service (Collection Counter, Council of Catholic Women, Knights of Columbus, Catholic Order of Foresters)
Would you like to enroll your child(ren) in our Religious Education program? Yes___ No___

Member 1 Information

Please Circle: Mr. Mrs. Miss Ms.

First Name:________________________________ Middle:_____________________ Last Name:__________________________________
Nickname:_____________________________ Maiden Name:___________________________ Gender (circle): Male Female
Date of Birth: ____/____/_______ Place of Birth: Country________________ City___________ State______
Home Phone: _________________________ Cell:_________________________ E-mail:_________________________________________

What is your occupation? ________________________________________________________________________________________
Do you have any areas of expertise that you would be willing to share with the parish? _______________________________________
______________________________________________________________________________________________________________

Sacramental Information
Baptized Catholic: Y N Date____/____/______ Church_______________________ Country__________ City___________ State____
Baptized (Other): Y N Date____/____/______ Faith________________________
Received in Catholic Church
1st Communion: Y N Date____/____/______ Church_______________________ Country__________ City___________ State____
Confirmation: Y N Date____/____/______ Church_______________________ Country__________ City___________ State____

Marital Status (circle) Single Married Divorced Annulled Widowed
Valid Catholic Marriage: Y N Date____/____/______ Church____________________ Country__________ City___________ State____

FOR PARISH USE ONLY
PS Registration Date_____________ Env#___________ Reactivated: Y/N Starter Set: Y/N Welcome Packet: Y/N Smore: Y/N
Ministries Contacted:_________________________________________________________________________________ Rev 2/2026

Member 2 Information

Please Circle: Mr. Mrs. Miss Ms. Family Role (circle): Spouse Minor: Son Daughter

First Name:________________________________ Middle:_____________________ Last Name:__________________________________
Nickname:_____________________________ Maiden Name:___________________________ Gender (circle): Male Female
Date of Birth: ____/____/_______ Place of Birth: Country________________ City___________ State______
Home Phone: _________________________ Cell:_________________________ E-mail:_________________________________________

What is your occupation? ________________________________________________________________________________________
Do you have any areas of expertise that you would be willing to share with the parish? _______________________________________
______________________________________________________________________________________________________________

Sacramental Information
Baptized Catholic: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Baptized (Other): Y N Date____/____/______ Faith________________________
Received in Catholic Church
1st Communion: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Confirmation: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____

Member 3 Information

Please Circle: Mr. Miss Family Role (circle): Minor: Son Daughter

First Name:________________________________ Middle:_____________________ Last Name:__________________________________
Nickname:_____________________________ Gender (circle): Male Female
Date of Birth: ____/____/_______ Place of Birth: Country________________ City___________ State______
Home Phone: _________________________ Cell:_________________________ E-mail:_________________________________________

Sacramental Information
Baptized Catholic: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Baptized (Other): Y N Date____/____/______ Faith________________________
Received in Catholic Church
1st Communion: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Confirmation: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____

Member 4 Information

Please Circle: Mr. Miss Family Role (circle): Minor: Son Daughter

First Name:________________________________ Middle:_____________________ Last Name:__________________________________
Nickname:_____________________________ Gender (circle): Male Female
Date of Birth: ____/____/_______ Place of Birth: Country________________ City___________ State______
Home Phone: _________________________ Cell:_________________________ E-mail:_________________________________________

Continued --->

Member 4 Information - continued

Sacramental Information
Baptized Catholic: Y N Date____/____/______ Church_______________________ Country__________ City___________ State____
Baptized (Other): Y N Date____/____/______ Faith________________________

Received in Catholic Church
1st Communion: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Confirmation: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____

Member 5 Information

Please Circle: Mr. Miss Family Role (circle): Minor: Son Daughter

First Name:________________________________ Middle:_____________________ Last Name:__________________________________
Nickname:_____________________________ Gender (circle): Male Female
Date of Birth: ____/____/_______ Place of Birth: Country________________ City___________ State______
Home Phone: _________________________ Cell:_________________________ E-mail:_________________________________________

Sacramental Information
Baptized Catholic: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Baptized (Other): Y N Date____/____/______ Faith________________________
Received in Catholic Church
1st Communion: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Confirmation: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____

Member 6 Information

Please Circle: Mr. Miss Family Role (circle): Minor: Son Daughter

First Name:________________________________ Middle:_____________________ Last Name:__________________________________
Nickname:_____________________________ Gender (circle): Male Female
Date of Birth: ____/____/_______ Place of Birth: Country________________ City___________ State______
Home Phone: _________________________ Cell:_________________________ E-mail:_________________________________________

Sacramental Information
Baptized Catholic: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Baptized (Other): Y N Date____/____/______ Faith________________________
Received in Catholic Church
1st Communion: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____
Confirmation: Y N Date____/____/______ Church_______________________ Country__________ City____________ State____

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