Immaculate Conception Church
Parish Registration
(PLEASE RIGHT-CLICK AND PRINT THIS, THEN RETURN TO CHURCH.)
Census information is strictly confidential Please fill out both sides Please print
Family (Last) Name:_______________________________________ Marital Status (please circle
one): Single Widow(er)
Separated Divorced
Address:___________________________________________ Married:
in Catholic Church? yes no Wedding date:_______________
- in non-Catholic
Church? yes no
City:_______________________ Zip Code:_____________
Phone Number:______________________
Unlisted? yes/no Do you wish contribution envelopes? ____________
Family information Sacraments received (yes or no) See
codes below for Mass
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Head of Household: |
Date of Birth |
Sex |
Religion: |
Baptism |
1st Communion |
Confirmation |
Attend Mass |
Mass time |
Occupation |
Special Needs |
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Spouse Name ( wife’s maiden): |
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Children living with you (last name if different):
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Other family members living
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Mass attendance: 1) weekly 2) monthly 3) seldom 4) daily Mass
times: 1) Saturday