Online Registration Form

Assumption of the Blessed Virgin Mary Catholic Church
Registration Form

Welcome to Assumption BVM Catholic Church! Please take a moment to tell us all about your family. You may be asked to provide more detailed information at a later date.

* Indicates required field

Choose One *

New Parishioner Existing Parishioner (Updating Family Information)

Family Information

Family (Last) Name: *

Address: *

City: *

State: *

Zip Code: *

Home Phone Number: *

Family Email: *

Would you like to contribution envelopes? *

Yes No

Envelope #: (for existing parishioners only) *

Head(s) of Household Information

Head of Household 1

First Name (1): *

Middle Name (1): *

Last Name (1): *

Maiden Name, If Applicable (1): *

Cell Phone Number (1): *

Email (1): *

Occupation (1): *

Baptized (1): *

Yes No

Received 1st Communion (1): *

Yes No

Confirmed (1): *

Yes No

Head of Household 2

First Name (2): *

Middle Name (2): *

Last Name (2): *

Maiden Name, If Applicable (2): *

Cell Phone Number (2): *

Email (2): *

Occupation (2): *

Baptized (2): *

Yes No

Received 1st Communion (2): *

Yes No

Confirmed (2): *

Yes No

Other(s) Living in Household Information

Person 1

First Name (3): *

Middle Name (3): *

Last Name (3): *

Gender (3): *

Male Female

Date of Birth (3): *

School Attending (3): *

Grade Level (3): *

Baptized (3): *

Yes No

Received 1st Communion (3): *

Yes No

Confirmed (3): *

Yes No

Person 2

First Name (4): *

Middle Name (4): *

Last Name (4): *

Gender (4): *

Male Female

Date of Birth (4): *

School Attending (4): *

Grade Level (4): *

Baptized (4): *

Yes No

Received 1st Communion (4): *

Yes No

Confirmed (4): *

Yes No

Person 3

First Name (5): *

Middle Name (5): *

Last Name (5): *

Gender (5): *

Male Female

Date of Birth (5): *

School Attending (5): *

Grade Level (5): *

Baptized (5): *

Yes No

Received 1st Communion (5): *

Yes No

Confirmed (5): *

Yes No

Person 4

First Name (6): *

Middle Name (6): *

Last Name (6): *

Gender (6): *

Male Female

Date of Birth (6): *

School Attending (6): *

Grade Level (6): *

Baptized (6): *

Yes No

Received 1st Communion (6): *

Yes No

Confirmed (6): *

Yes No

Person 5

First Name (7): *

Middle Name (7): *

Last Name (7): *

Gender (7): *

Male Female

Date of Birth (7): *

School Attending (7): *

Grade Level (7): *

Baptized (7): *

Yes No

Received 1st Communion (7): *

Yes No

Confirmed (7): *

Yes No

Additional Comments: *

Submit

Assumption of the ​Blessed Virgin Mary

Assumption of the Blessed Virgin Mary Catholic Church Registration Form

Family Information

Head(s) of Household Information

Head of Household 1

Head of Household 2

Other(s) Living in Household Information

Person 1

Person 2

Person 3

Person 4

Person 5

​​​Phone: (337) 873-6574​​​Email: assumptionmire@gmail.comFacebook: Assumption of The Blessed Virgin Mary

Assumption of the
Blessed Virgin Mary

Assumption of the Blessed Virgin Mary Catholic Church
Registration Form

Phone: (337) 873-6574
Email: assumptionmire@gmail.com
Facebook: Assumption of The Blessed Virgin Mary