Online Registration

Directions: Please complete this form. To move to the next box, please use the tab key. To insure that the form comes from you, please type the word Register in the box asking you to confirm your registration. When the form is complete, press the send button on the bottom of the form. Thank you.

Mailing/Contact Information:

Family Name*

Address*

City*

State*

Zip*

Phone (xxx-xxx-xxxx)*

I would like to receive the Nativity News Letter emailed to the above address:*

May we use your email address for other parish communications?*

Parish History:

Previous Parish*

City and State*

Family Information:

First Name*

Date of Birth*

Religion

Baptized?

Church of Baptism

Confirmed?

Church of Confirmation

Occupation and Company Name

Work Phone

Spouse:

Spouse’s Name

Date of Birth

Religion

Baptized?

Church of Baptism

Confirmed?

Church of Confirmation

Occupation and Company Name

Work Phone

Marital Status

Date of Marriage

Church of Marriage

Children Living At Home:

Name

Gender

Birth date

Place of Birth

School Attending

Grade

Baptismal Date

Church of Baptism

Confirmation Date

Church of Confirmation

Name

Gender

Birth date

Place of Birth

School Attending

Grade

Baptismal Date

Church of Baptism

Confirmation Date

Church of Confirmation

Name

Gender

Birth date

Place of Birth

School Attending

Grade

Baptismal Date

Church of Baptism

Confirmation Date

Church of Confirmation

Name

Gender

Birth Date

Place of Birth

School Attending

Grade

Baptismal Date

Church of Baptism

Confirmation Date&

Church of Confirmation

Notes:

Confirm Your Registration by typing the word Register in the box below :