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Parish Census Update / Actualización De Datos

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  Head of Household / Cabeza de Familia
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email / Correo Electrónico REQUIRED Please fill out this field. Please enter an email address.
  
  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.
  
  Spouse / Esposa(o)
  
  Name / Nombre Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento Please enter a date.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Email / Correo Electrónico Please enter an email address.
  
  Number of Children at Home / Número de Niños en la Casa REQUIRED
  List each individual child / Enumere cada niño(a)
  Please fill out this field.
  
  Child / Nino(a) 1
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 2
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 3
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 4
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 5
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 6
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 7
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Child / Nino(a) 8
  
  Name / Nombre REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth / Fecha de Nacimiento REQUIRED Please fill out this field. Please enter a date.
  
  School Grade / Grado Escolar
  
  Are you registered in the Parish? / Está Inscrito en la Parroquia? REQUIRED Yes / Sí No Please fill out this field.
  
  May we help you register? / Podemos ayudarle a inscribers? Yes / Sí No
  
  Submit
  
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