Parish Registration Form

- Faith Formation

Parish Registration

Please fill out the following information to register at St. Therese of Lisieux.
Fill out each question. If it does not pertain to you, type N/A.
Registration Form
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- Family Name: Last REQUIRED Please fill out this field. Please enter valid data.
- First Name REQUIRED Please fill out this field. Please enter valid data.
- Spouse Name Please enter valid data.
- Wife's Maiden Name Please enter valid data.
- Title REQUIRED Please fill out this field.
- P.O. Box Please enter valid data.
- Street Address REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email Please enter an email address.
- Phone Number Please enter a phone number.
- Cell Phone Number Please enter a phone number.
- May information be published in our directory? REQUIRED Please fill out this field.
- Date Registered REQUIRED Please fill out this field. Please enter a date.
- Marital Status: REQUIRED Please fill out this field.
- # children at home Please enter an integer (number).
- Method of Contributions REQUIRED Please fill out this field.
- Please fill out the following information for EACH member of your household. The first question asks how many members. Please include yourself and, if any, spouse or children living at home.
- Members REQUIRED Please fill out this field.
  
  Member 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
  
  Member 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
  
  Member 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
  
  Member 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
  
  Member 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
  
  Member 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
  
  Member 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Handicap REQUIRED Please fill out this field. Please enter valid data.
  
  Languages spoken REQUIRED Please fill out this field. Please enter valid data.
  
  Occupation / Student REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Employer / School REQUIRED Please fill out this field. Please enter valid data.
  
  Business Phone / Extension Please enter valid data.
  
  Grade School / Escuela REQUIRED Please fill out this field.
  
  Sex REQUIRED Please fill out this field.
  
  Birthdate REQUIRED Please fill out this field. Please enter a date.
  
  Answer YES or NO for each sacrament received, list WHERE if yes.
  
  BAPTISM REQUIRED Please fill out this field. Please enter valid data.
  
  PENANCE REQUIRED Please fill out this field. Please enter valid data.
  
  1ST COMMUNION REQUIRED Please fill out this field. Please enter valid data.
  
  CONFIRMATION REQUIRED Please fill out this field. Please enter valid data.
  
  MARRIAGE DATE REQUIRED Please fill out this field. Please enter valid data.
  
  Other information
  
  MINISTRIES
  Choose all that apply
  Knights of Columbus St Therese Women of Faith CCW Youth Ministry Religious Education Ministry Cursillo Music Ministry Hispanic Ministry Social Action Ministry Parish Life Ministry Colombia Mission Ministry None at this time
  
  TALENTS Please enter valid data.
  
  WOULD LIKE TO VOLUNTEER FOR
Submit

St. Thérèse of Lisieux

Catholic Church

Parish Registration Form

Parish Registration

Registration Form