Skip to content

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

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

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?

First

Middle

Last

Ethnicity

Other
Caucasian
Latino
Asian
Native American
African American

Primary phone number *

Secondary phone number (Optional)

Email

Address

Address Line 1

Address Line 2

City

State

Zip Code

Additional information about head of household. (Marital status) *

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

Personal adult data

Adult 1 Full legal name

First

Middle

Last

Ethnicity

Other
Caucasian
Latino
Asian
Native American
African American

Date of birth

Sex

Male
Female

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?

Occupation

Multiple Choice

English
Spanish
Preferred language is not listed

If preferred language is not listed please enter below and we will try and get a translator.

Personal adult data

Adult 2 Full legal name

First

Middle

Last

Ethnicity

Other
Caucasian
Latino
Asian
Native American
African American

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?

Accupation

Multiple Choice

English
Spanish
Preferred language is not listed

If preferred language is not listed please enter below and we will try and get a translator.

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

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

Additional information

Applicant name *

First

Middle

Last

Applicant phone number *

Applicant email *

Do you have any questions or concerns?

Comment

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

Need help?

Traductora de españo