Online Registration Form Registration FormInstructions To move from field to field, please use the tab key or click on it with your mouse. The fields with a red star * next to it must be filled in before the form will send. When entering a month, it must be a two digit number. Example January needs to entered as 01, February as 02, etc.Registration Date General InformationFamily Name *Home Phone *Address *Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryEmail 1 Email 2 I would like to receive the weekly "Nativity News" by email YesNoYou can use my email for other communications YesNoParish HistoryPrevious Parish Address Street AddressApt, Suite, Bldg. (optional)CityState / Province / RegionPostal / Zip CodeAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo (Brazzaville)CongoCosta RicaCote d\'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalestinian TerritoryPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWestern SaharaWestern SamoaYemenZambiaZimbabweCountryFamily InformationFirst Name (please include maiden) *Birth Date *You can ignore the calendar and just type the dateReligion *Cell Phone Baptized *YesNoUnsureChurch Baptized Confirmed *YesNoUnsureChurch Confirmed Occupation and Company Name Work Phone Spouse's Name Birth Date Religion Cell Phone Baptized YesNoUnsureChurch Baptized Confirmed YesNoUnsureChurch Confirmed Occupation and Company Name Work Phone Marital Status *MarriedSingleDivorcedSeperatedDate of Marriage Church Married Please list any information priest/staff may be able to assist you with. Children #1 At HomeName of Child Gender MaleFemaleDate of Birth Place of Birth School Attending Grade Level NonePreschoolKindergarten123456789101112Post Secondary / OtherDate of Baptism Please enter month and year. Example: 09/2018.Church of Baptism Date of First Eucharist Please enter month and year. Example: 01/2016.Church of 1st Eucharist Date of Confirmation Please enter month and year. Example: 03/2015.Church of Confirmation Child #2 at HomeName of Child Gender MaleFemaleDate of Birth Place of Birth School Attending Grade Level NonePreschoolKindergarten123456789101112Post Secondary / OtherDate of Baptism Please enter month and year. Example: 09/2018.Church of Baptism Date of First Eucharist Please enter month and year. Example: 09/2018.Church of First Eucharist Date of Confirmation Please enter month and year. Example: 09/2015Church of Confirmation Child #3 at HomeName Gender MaleFemaleDate of Birth Place of Birth School Attending Grade Level NonePreschoolKindergarten123456789101112Post Secondary/OtherDate of Baptism Please enter month and year. Example: 09/2018.Church of Baptism Date of First Eucharist Please enter month and year. Example: 09/2018.Church of First Eucharist Date of Confirmation Please enter month and year. Example: 09/2018.Church of Confirmation Child #4 at HomeName Gender MaleFemaleDate of Birth Place of Birth School Attending Grade Level NonePreschoolKindergarten123456789101112Post Secondary / OtherDate of Baptism Please enter month and year. Example: 09/2018.Church of Baptism Date of First Eucharist Please enter month and year. Example: 09/2018.Church of First Eucharist Date of Confirmation Please enter month and year. Example: 09/2018.Church of Confirmation SectionSection Fieldset VerificationPlease enter any two digits *Example: 12This box is for spam protection - <strong>please leave it blank</strong>:
