Parish Registration

Below is the Light of Christ Parish Registration Form
**Please Fill In Completely**

General Information

Family Name:

Marital Status:

Street Address:

City:

State:

Zip:

Home Phone:

Family Email:

Male Information

Cell Phone:

Place of Employment:

Work Number:

Female Information

Cell Phone:

Place of Employment:

Work Number:

Maiden Name:

Wedding Date:

Member Information

Male

First Name:

Last Name:

Birth Date:

Gender:

Occupation / School:

Religion:

Baptism (Church & Date):

Eucharist (Church & Date):

Reconciliation (Church & Date):

Confirmation (Church & Date):

Female

First Name:

Last Name:

Birth Date:

Gender:

Occupation / School:

Religion:

Baptism (Church & Date):

Eucharist (Church & Date):

Reconciliation (Church & Date):

Confirmation (Church & Date):

Child 1

First Name:

Last Name:

Birth Date:

Gender:

Occupation / School:

Religion:

Baptism (Church & Date):

Eucharist (Church & Date):

Reconciliation (Church & Date):

Confirmation (Church & Date):

Child 2

First Name:

Last Name:

Birth Date:

Gender:

Occupation / School:

Religion:

Baptism (Church & Date):

Eucharist (Church & Date):

Reconciliation (Church & Date):

Confirmation (Church & Date):

Child 3

First Name:

Last Name:

Birth Date:

Gender:

Occupation / School:

Religion:

Baptism (Church & Date):

Eucharist (Church & Date):

Reconciliation (Church & Date):

Confirmation (Church & Date):

Child 4

First Name:

Last Name:

Birth Date:

Gender:

Occupation / School:

Religion:

Baptism (Church & Date):

Eucharist (Church & Date):

Reconciliation (Church & Date):

Confirmation (Church & Date):

Please confirm your information by entering the code in the box below.

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