ST. JOHN LALANDE CATHOLIC CHURCH Date: _____________ 805 N.W. R.D. Mize Road Blue Springs, Missouri 64015 (816)229-3378/Fax: (816)229-1362 Email:
[email protected]
Parish Registration Form Family Information Preferred Title for Mail: _____Mr. _____Mrs. _____Miss _____Ms. _____Mr. & Mrs. Head of Household Name: _______________________________________________ Last
First
M.I.
Spouse Name: ______________________________________________________________ Last
First
M.I.
Home Phone: _________________________Cell Phone HOH______________ Cell Phone Spouse
____
___
Home Address: ______________________________________________________________ ____________________________________________________________________________ City
State
Zip Code
Home Email: _________________________________________________________________ Please use my □ Name, □ Address, □Phone Number, □Email for office use only.
Occupation Head of Household Employer: __________________________________________________ Work Phone: ______________________ Self Employed: _____Yes _____No
Title: ______________________________ Job Description: _____________________ Spouse Employer: ____________________________________________________________ Work Phone: ______________________ Self Employed: _____Yes _____No Title: ______________________________ Job Description: _____________________ Please turn to complete
Revised 01-19-2017
Other Information Marital Status: ____Catholic Marriage _____Single
____Other Marriage ____Separated
____Widowed ____Divorced
Wedding Date: _____________________ Wedding Church/City: ____________________________________________________ Special Needs: __________________________________________________________
Family Sacramental Information Name
Religion
Sex
Date of Birth
Grade In School
Baptism
Head of Household
Yes
Spouse
Yes
No
Date
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
Yes Date
Yes
Yes
Yes
Yes
No
Yes
No
Yes Date
No
Yes
No
Yes
No
Date No
Yes
No
Date No
Yes
No
Date No
Yes
No
Date No
Date No
Yes
Date
Date
Date
Other Adult in Home
No
Date
Date
Child
Yes
No
Date
Date
Date
Child
No
Date
Date
Child
Yes
Yes Date
Date
Date
Child
No
Date
Date
Child
Yes Date
Date
Child
Confirmed 1st Communion
Yes
No
Date No
Yes
No
Date
Registration Date________________________Welcome Letter __________________
