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Outreach Center Ministry
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Donate
HOME
Information
Services
- Parish Pastoral Council
- Virtual Tour
Ministries
Outreach Center Ministry
Search for:

New member registration

If you need assistance please call the Parish office.

If no children please leave child area empty.

Who is the head of household? Adult #1 *

First

Middle

Last

Date of birth

Sacraments Received (Please mark all that apply)

Baptism
1st Communion
Confirmation

Sex

Male
Female

Multiple Choice

English
Spanish

If preferred language is not listed please enter below.

Ethnicity

Caucasian
Latino
Asian
Native American
African American
Other

Primary phone number *

Email *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Marital status *

Divorced
Engaged
Living together
Married in church
Civil marriage
Separated
Single
Single Parent
Widowed

Parish Support

I would like to receive envelopes
I would like to sign up for automatic withdrawal

Spouse (if applicable) Adult #2

Adult 2 Full legal name

First

Middle

Last

Date of birth

Sacraments Received (Please mark all that apply)

Baptism
1st Communion
Confirmation

Sex

Male
Female

Multiple Choice

English
Spanish

If preferred language is not listed please enter below.

Ethnicity

Caucasian
Latino
Asian
Native American
African American
Other

Phone number

Personal Children data

If no children please leave the following questions empty.

Child 1 Full legal name

First

Middle

Last

Sex

Male
Female

Date of birth

Baptismal date

Where did the Baptismal take place?

Reconciliation date

Where did the Reconciliation take place?

First communion date

Where did the first communion take place?

Attending school

Child 2

Child Full legal name

First

Middle

Last

Sex

Male
Female

Date of birth

Baptismal date

Where did the Baptismal take place?

Reconciliation date

Where did the Reconciliation take place?

First communion date

Where did the first communion take place?

Attending school

Child 3

Child Full legal name

First

Middle

Last

Sex

Male
Female

Date of birth

Baptismal date

Where did the Baptismal take place?

Reconciliation date

Where did the Reconciliation take place?

First communion date

Where did the first communion take place?

Attending school

Child 4

Child Full legal name

First

Middle

Last

Sex

Male
Female

Date of birth

Baptismal date

Where did the Baptismal take place?

Reconciliation date

Where did the Reconciliation take place?

First communion date

Where did the first communion take place?

Attending school

Child 5

Child Full legal name

First

Middle

Last

Sex

Male
Female

Date of birth

Baptismal date

Where did the Baptismal take place?

Reconciliation date

Where did the Reconciliation take place?

First communion date

Where did the first communion take place?

Attending school

Child 6

Child Full legal name

First

Middle

Last

Sex

Male
Female

Date of birth

Additional information

Applicant name

First

Middle

Last

Do you have any questions or comments?

Email

Stmark-Kenosha.org is maintained by its members. Updated 6/23/2014.

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