Online Parish Registration Form ** Please note** This form can only accommodate (6) family members or less. If more family members, you will need to complete our paper registration form. Thank you for registering with us! "*" indicates required fields 1Registrant Information2Preferences3Children4Additional Information5678 Registration FormRegistration Type* New Parishioner Registration Returning Parishioner Registration Registrant InformationTitle* Mr. Mrs. Ms. Miss Dr. Other Registrant Name* First Middle Last Goes By (Preferred Name)*Gender* Male Female Maiden Name*Birth Date* MM slash DD slash YYYY Marital Status* Single Married Divorced Separated Widowed Address* Street Address Address Line 2 City ZIP Code Subdivision/Apartment*If neither, type ‘None’Primary Contact Phone*Email Address* Previous Parish of Registration*Please include city and state. If no previous parish, please type ‘None’ Religion*If ‘Other’, please indicate religion or type ‘None’ in the box below. Roman Catholic Other List any Special NeedsEmergency Contact InformationEmergency Contact Name*Please list someone not living in your home. First Middle Last Emergency Contact's Relationship to Registrant*Emergency Contact's Phone Number* Spouse InformationTitle (Registrant)* Mr. Mrs. Ms. Miss Dr. Other Spouse's Name* First Middle Last Gender* Male Female Goes By (Preferred Name)*Maiden Name*Birth Date* MM slash DD slash YYYY Primary Contact Phone*Email* Religion*If ‘Other’, please indicate religion or type ‘None’ in the box below. Roman Catholic Other List any Special Needs PreferencesWould you like to receive a free subscription to the Archdiocesan newspaper? (The Georgia Bulletin)* Yes No Publish Contact Information?*i.e. photo directory Yes No Do you have children that you wish to add to this registration?*Adults ages 18 or over should be registered separately. Yes No Child #1Child's Name* First Middle Last Goes By (Preferred Name)*Birth Date* MM slash DD slash YYYY Gender* Male Female Religion*If ‘Other’, please indicate religion or type ‘None’ in the box below. Roman Catholic Other GradeSchool AttendingSacraments Received*Please check all that apply. Baptism First Communion Confirmation Marriage None List any Special NeedsDo you have a second child to add to this registration form?* Yes No Child #2Child's Name* First Middle Last Goes By (Preferred Name)*Birth Date* MM slash DD slash YYYY Gender* Male Female Religion*If ‘Other’, please indicate religion or type ‘None’ in the box below. Roman Catholic Other GradeSchool AttendingSacraments Received*Please check all that apply. Baptism First Communion Confirmation Marriage None List any Special NeedsDo you have a third child to add to this registration form?* Yes No Child #3Child's Name* First Middle Last Goes By (Preferred Name)*Gender* Male Female Birth Date* MM slash DD slash YYYY Religion*If ‘Other’, please indicate religion or type ‘None’ in the box below. Roman Catholic Other GradeSchool AttendingSacraments Received*Please check all that apply. Baptism First Communion Confirmation Marriage None List any Special NeedsDo you have a fourth child to add to this registration form?* Yes No Child #4Child's Name* First Middle Last Goes By (Preferred Name)*Gender* Male Female Birth Date* MM slash DD slash YYYY Religion*If ‘Other’, please indicate religion or type ‘None’ in the box below. Roman Catholic Other GradeSchool AttendingSacraments Received*Please check all that apply. Baptism First Communion Confirmation Marriage None List any Special NeedsAre there more children that need to be added to your registration?*If ‘Yes’ , someone from our office will contact you. Yes No Information Request:Please contact me in regard to: Child(ren) (Under 18) Religious Education Baptism Confirmation First Communion Reconciliation Please contact me in regard to: Adult (18 and Older) Religious Education Baptism Confirmation First Communion Reconciliation I want to find out more about… Coming back to the Church Becoming Catholic Being married in the Church Annulments Other Additional Comments:
