Annual Registration

Please indicacate your area of interest by checking boxes CCD Ministros litúrgicos Diversos grupos parroquiales Superación Coro Otro

Other: Please enter valid data.

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

Family Last Name Please enter valid data.

Address 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Cell Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Stewardship Pledge $10 Weekly $20 Weekly $25 Weekly $30 Weekly $35 Weekly $40 Weekly Other

Other Please enter valid data.

Heads of Household

Name Please enter valid data.

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

Baptized Yes No

1st Communion Yes No

Confirmation Yes No

Marital Status Yes No

Name Please enter valid data.

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

Baptized Yes No

1st Communion Yes No

Confirmation Yes No

Marital Status Yes No

Are you Married by the Catholic Church Yes No

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

If not married by the catholic Church, would you like more information on receiving the sacrament? Yes No

Children Living at Home

Children Living at Home

Children Living at Home

Children Living at Home

Children Living at Home

Children Living at Home

Nuestra Señora del Perpetuo Socorro