PARISHIONER REGISTRATION FORM

FAMILY INFORMATION

FAMILY / LAST NAME REQUIRED Please fill out this field. Please enter valid data.

Address 1 REQUIRED Please fill out this field. Please enter valid data.

Address 2 Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Languages spoken in the home, other than English Please enter valid data.

If you have children registered in Our Lady of Mercy Academy or in our Religious Education Program, please indicate below OLMA School Family OLM Religious Education Family

__________________________

Please select the total number of family members living in your home. Then fill in the information required for each member.

Total number of Family Members REQUIRED Please fill out this field.
Member 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments
Member 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments
Member 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments
Member 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments
Member 5
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments
Member 6
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments
Member 7
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Date of Birth REQUIRED
  mm/dd/yyyy
  Please fill out this field. Please enter valid data.
- Gender Male Female
- Marital Status REQUIRED Please fill out this field.
- If married, Church of Marriage Please enter valid data.
- Family Relation REQUIRED Please fill out this field.
- Occupation / Student Current Grade Please enter valid data.
- Religion REQUIRED Please fill out this field. Please enter valid data.
- Sacraments Baptism 1st Reconciliation 1st Eucharist Confirmation
- Email, if applicable Please enter an email address.
- Maiden Name, if applicable Please enter valid data.
- Comments