Registration

Date REQUIRED Please fill out this field. Please enter a date.

Are you transferring parishes? Yes No

If yes, please list parish name, city, and diocese Please enter valid data.

HEAD(S) OF HOUSEHOLD ( Please list separately)

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Date of Birth REQUIRED Please fill out this field. Please enter valid data.
Religion (ex. Catholic) Please enter valid data.
Sacraments Received ( check all that apply) Baptism Confirmation
Place of Employment Please enter valid data.
Phone Number Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Household 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.

Relationship Status Single Married Widowed Divorced

If Married, Date Please enter valid data.

Wife's Maiden Name Please enter valid data.

In the Catholic Church (Y/N) Please enter valid data.

If No, was permission granted by the Bishop (Y/N) Please enter valid data.

Place of Wedding (Church, City, State) Please enter valid data.

SPOUSE

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.
Gender M F
Date of Birth Please enter valid data.
Religion Please enter valid data.
Sacraments Received ( check all that apply) Baptism Confirmation
If you have more dependents then spaces avaiable please contact the parish office @ 223-1549.
Would you like to receive envelopes Yes No
If no, please fill out the ACH automatic deposit form at the top of the page and return to the parish office.

Church of Saint Anne