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Join Our Parish Registration Form
(Or download PDF and turn into parish office)
Join our parish by filling in the requested information below.
Date
*
Name
*
First
Last
Email
*
Address
*
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Phone
*
Contribution Envelopes
Yes
No
Electronic Debit
Yes
No
"Catholic Review" magazine (home delivery 4x a year)
Yes
No
Household Information
Marital Status:
*
Married
Single
Widowed
Divorced
Married by Priest/Deacon
Yes
No
Wedding Date
Wedding Church/City, State
Male Head of Household/ Husband
Name
First
Last
DOB
Check if Sacrament received:
Baptism
Reconciliation
First Eucharist
Confirmation
Catholic
Yes
No
Occupation
Cell Phone
Email
Ministry I would like to be involved in: (Please call me)
Female Head of Household/ Wife
Name (Include Maiden Last Name)
First
Last
DOB
Check if Sacrament received:
Baptism
Reconciliation
First Eucharist
Confirmation
Catholic
Yes
No
Occupation
Cell Phone
Email
Ministry I would like to be involved in: (Please call me)
Children in Household
Please complete for each individual child and send an email to Patty.Pelszynski@sjerc.org if more than four children need to be enrolled.
Name Child #1
First
Last
DOB
Sex
Male
Female
Special Needs
Check if Sacrament received:
Baptism
Reconciliation
First Eucharist
Confirmation
Date of Baptism
Date of Reconciliation
Date of First Eucharist
Date of Confirmation
Catholic
Yes
No
Name Child #2
First
Last
DOB
Sex
Male
Female
Special Needs
Check if Sacrament received:
Baptism
Reconciliation
First Eucharist
Confirmation
Date of Baptism
Date of Reconciliation
Date of First Eucharist
Date of Confirmation
Catholic
Yes
No
Name Child #3
First
Last
DOB
Sex
Male
Female
Special Needs
Check if Sacrament received:
Baptism
Reconciliation
First Eucharist
Confirmation
Date of Baptism
Date of Reconciliation
Date of First Eucharist
Date of Confirmation
Catholic
Yes
No
Name Child #4
First
Last
DOB
Sex
Male
Female
Special Needs
Check if Sacrament received:
Baptism
Reconciliation
First Eucharist
Confirmation
Date of Baptism
Date of Reconciliation
Date of Confirmation
Catholic
Yes
No
Menu
Our Parish
History
Mission
Vision Plan
Locations
Our Clergy
Our Associates
Pastoral Council
Committee Chairs
Staff
Parish Ministries
List of Ministries
Liturgy
Music
Singles
Social
Legislative Advocacy
Global Justice & Peace
Healing Community
To Serve with Love
Youth
LifeTeen
EDGE
Volunteer
Diversity
Hispanic Ministry
Business Administration
Sacraments
Baptism
Youth Confirmation
Adult Confirmation
First Communion
Reconciliation
Sacrament of the Sick
Matrimony
Holy Orders
Faith Formation
Religious Education K-6 Grade
Programs for Adults
Becoming Catholic/RCIA
Bible Study
Youth
LifeTeen
EDGE
Outreach
Welcoming Ministry
Returning to the Church
Small Church Communities (SCC)
Join Our Parish
Giving
Contact Us
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5885 Robert
10431 Twin Rivers