Please print clearly and fill out registration completely – all information is needed Date:
Last name _________________________________ First name ____________________________

Middle name _______________________ If married woman-maiden name ___________________________

Street address _____________________________________________________________________________

City _____________________________________ Work phone (_____) ________________________________

Cell (_____) ___________________________  Email ________________________________________________

Date of birth ______/______/______  Place of birth _________________________________________________

WHAT IS YOUR REASON FOR JOINING THE R.C.I.A. PROGRAM?

___ I want to be baptized in the Catholic Church

___ I want to be received into the Catholic Church

___ I want to receive the Sacrament of 1st Communion

___ I want to receive the Sacrament of Confirmation

___ I am searching and would like to know more about the Catholic Church

___ I am Catholic but would like to know more about my Catholic faith

___ I am a sponsor for someone entering the Church

Are you baptized? _____ Yes  _____No          If yes, date of Baptism ______/______/______

___ Catholic    ______Protestant

Name of Church ___________________________________________________________________________

Address ____________________________________________ St. ______________ Zip ___________________

Father’s last name ____________________________ First name ________________________ Initial __________

Mother’s last name ___________________________ First name _________________________ Initial _________

Maiden’s name_________________________________

IF BAPTIZED, CATHOLIC OR PROTESTANT, A COPY OF THE BAPTISMAL CERTIFICATE IS REQUIRED

Marital Status ____ Single  ____Engaged ____ Married ____ Separated ____ Divorced ____Widowed

If married, is this a first marriage? ____ Yes ____ No If no, was previous marriage annulled? ____ Yes ____ No

If married, was this marriage blessed by the church? ____ Yes ____ No

Date of marriage ____/____/______ Church or place of marriage ______________________________________

Address ____________________________________________________ City ___________________________

State _______________ Zip Code ________________________

Do you have children ____ Yes ____ No   Names of children ___________________________________________

______________________________________________________________________________________________

Sponsor  last name ______________________  First name  _____________________ Initial _____________

Name of their Church _________________________________________________________________________

Address _____________________________________________________________________________________

City _________________________________________ State________________________ Zip Code ____________

REQUIREMENTS : ATTEND WEEKLY MEETINGS  AND ATTEND SUNDAY MASS (8, 9:30, 11:30 AM)

Baptismal Certificate received _________ Sponsor certificate received _________