St. Therese of the Child Jesus Catholic Church

Registration Form - English

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Home Address

Phone #1 *
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    Phone #2
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      Mr
      Marital Status
      Married in Catholic Church
      Civil Married
      Never Married
      Living with Girlfriend
      Divorced
      Widower
      Last Name
      Occupation
      First Name
      Work Phone
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        Miss
        Marital Status
        Married in Catholic Church
        Civil Married
        Never Married
        Living with Boyfriend
        Divorced
        Widower
        Last Name
        Occupation
        First Name
        Work Phone
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          Family information of all who live in your house (under 18 yrs old)

          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          First and Last Name
          Gender
          M
          F
          First Communion
          Y
          N
          Date of Birth
          Confirmation
          Y
          N
          Baptized
          Y
          N
          Interested in Online Giving?
          Y
          N
          Reason for Registration
          Sacraments
          School
          New to Area
          Catechesis
          Notes
          Submit
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