REGISTRATION

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Marital Status REQUIRED Please fill out this field. Please enter valid data.

Spouse's Name REQUIRED Please fill out this field. Please enter valid data.

Spouse's Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Spouse's Religion REQUIRED Please fill out this field. Please enter valid data.

Please complete for each child Residing at Home: Child’s Name; Date of Birth; School: Baptized, Eucharist, Confirmed

Church you wish to be registered at: REQUIRED Our Lady of Mercy St. Benedict St. Joseph Sacred Heart St. Michael Queen of Peace St. Thomas d'Aquin Please fill out this field.

Do you wish to be issued a set of Sunday Offertory Envelopes (If yes, our office will contact you with the necessary information.)) REQUIRED Yes No Please fill out this field.

Or, would you prefer to make your donations to the Parish by means of Direct Electronic Funds Transfer? (If yes, our office will contact you with the necessary information and forms.) REQUIRED Yes No Please fill out this field.