Family Last Name:
Mailing Address:
Physical Address:
Town:
State: Zip Code:
Phone Number: Second Phone:

List below names of all living in the household as one family. List all unmarried adult children
as well as minors. Where last name of child or other adult in the Family is different than above be
sure to include this name.

Male First Name, Middle Initial:
Date of Birth: MM/DD/YYYY:       Race:
Sex:                                Status:                       Catholic:
Baptized Catholic:     First Communion:        Confirmation:
Mass Attendance:                             Received Communion:
Married by priest:    Occupation or school:

Female First Name, Middle Initial:
Date of Birth: MM/DD/YYYY:       Race:
Sex:                            Status:                            Catholic:
Baptized Catholic:    First Communion:          Confirmation:
Mass Attendance:                                Received Communion:
Married by priest:     Occupation or school: Skip down

First Name, Middle Initial:
Date of Birth: MM/DD/YYYY:    Race:
Sex:               Status:                    Catholic:
Baptized Catholic:     First Communion:          Confirmation:
Mass Attendance:          Received Communion:
Child receiving religious education:
Occupation or school: Skip down

First Name, Middle Initial:
Date of Birth: MM/DD/YYYY:                    Race:
Sex:                Status:                   Catholic:
Baptized Catholic:      First Communion:        Confirmation:
Mass Attendance:           Received Communion:
Child receiving religious education:
Occupation or school: Skip down

First Name, Middle Initial:
Date of Birth: MM/DD/YYYY:                    Race:
Sex:                Status:                     Catholic:
Baptized Catholic:       First Communion:        Confirmation:
Mass Attendance:             Received Communion:
Child receiving religious education:
Occupation or school: Skip down

First Name, Middle Initial:
Date of Birth: MM/DD/YYYY:                    Race:
Sex:                Status:                     Catholic:
Baptized Catholic:       First Communion:        Confirmation:
Mass Attendance:             Received Communion:
Child receiving religious education:
Occupation or school:

Does the family receive the Catholic Commentator?
Does the family receive tithing envelopes?
Would anyone like more information on the parish or parish activities?
Would any member like additional information on the Catholic Church?
Does anyone have any special needs? (Please list below)

Does anyone have any special skills or talents that can be used in the ministry of the church?