Register Welcome! Please complete this form to register as a parishioner at Old St. Mary’s. Your Name* Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Email Address* Home Phone NumberMobile Phone NumberWork Phone NumberAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Birthday Date Format: MM slash DD slash YYYY Are you Catholic?YesNoSacraments you have received: Baptism First Confession First Holy Communion Confirmation Select all that apply.What is the highest level of education you have received?High SchoolCollegePost GraduateName of Spouse Mr.Mrs.MissMs.Dr.Prof.Rev. Prefix First Last Birthday Date Format: MM slash DD slash YYYY Is your spouse Catholic?YesNoSacraments your spouse has received: Baptism First Confession First Holy Communion Confirmation Select all that apply.What is the highest level of education your spouse has received?High SchoolCollegePost GraduateAre you and your spouse married in the Catholic Church?YesNoDate of Marriage Date Format: MM slash DD slash YYYY At what other churches do you intend on attending Mass?Which Mass do you and your family predominantly attend?LatinGermanEnglishChoose one.ChildrenDo you and your spouse have children?YesNoHow many children?How are your children receiving religious formation? School Homeschool CCD Other Select all that apply.Name of First Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Second Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Third Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Fourth Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Fifth Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Sixth Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Seventh Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Name of Eighth Child First Last Birthday Date Format: MM slash DD slash YYYY What sacraments has this child NOT received? Baptism First Confession First Holy Communion Confirmation Select all that apply.Parish Activities and VolunteeringPlease indicate any of the below activities you or your children would like to be involved in at Old St. Mary's: Altar Server Usher Choir RCIA Team Marriage Prep Team Church Cleaning Office Volunteer Maintenance Volunteer Altar Society Vestment Making / Repair Other (please describe in field below) Select all that apply.Please describe the "Other" parish activities that you would like to be involved in:NameThis field is for validation purposes and should be left unchanged.
