St. Mary of the Annunciation Parish Family Registration Form

24 Conant Street, Danvers, MA 01923

Family Information

Last Name:

Required*

First Name(s):

Required*

Mailing Name:

(ie Mr. & Mrs. John Doe)

Address:

Street 1*

Street 2

City*

State*

Zip*

Phone Number:

Emergency Phone Number:

Family E-mail Address:

Individual Member Information (adult 1)

Information on Dependent Children should be listed in the Dependent Children section

Role:

(Head of House, Husband, Wife etc.)

Name:

First Name*

Last Name*

Nickname:

Date of Birth

MM/DD/YYYY * //

E-mail:

Home Phone Number:

Cell Phone Number:

Occupation/Employer:

Marital Status:

(Single, Married, Separated, Divorced, Annulled)

Sacraments Received?

	Baptism
	Reconciliation
	First Eucharist
	Confirmation
	Valid Catholic Marriage

Individual Member Information (adult 2):

Role:

(Head of House, Husband, Wife etc.)

Name

First Name

Last Name

Nickname:

Date of Birth:

MM/DD/YYYY //

E-mail:

Home Phone Number:

Cell Phone Number:

Occupation/Employer:

Marital Status:

(Single, Married, Separated, Divorced, Annulled)

Sacraments Received?

	Baptism
	Reconciliation
	First Eucharist
	Confirmation
	Valid Catholic Marriage

Dependent Child Information (1)

Relationship to Head of Household:

(ie son, daughter, granddaughter, grandson, mother, father etc)

Name

First Name

Last Name

Gender:

	Female
	Male

Date of Birth:

(MM/DD/YYYY)

School:

Baptism?

Please note the location and the date of Baptism if received

First Eucharist?

Please note the location and the date of First Eucharist if received.

Reconciliation?

Please note the location and the date of First Reconciliation if received.

Confirmation?

Please note the location and the date of Confirmation if received.

Dependent Child Information (2)

Relationship to Head of Household:

Name

First Name

Last Name

Gender:

	Female
	Male

Date of Birth:

MM/DD/YYYY

School:

Baptism?

Please note the location and the date of Baptism if received.

First Eucharist?

Please note the location and the date of First Eucharist if received.

Reconciliation?

Please note the location and the date of First Reconciliation if received.

Confirmation?

Please note the location and the date of Confirmation if received.

Dependent Child (3)

Relationship to Head of Household:

Name:

First Name

Last Name

Gender:

	Female
	Male

Date of Birth:

MM/DD/YYYY

School

Baptism?

Please note the location and the date of Baptism if received.

First Eucharist?

Please note the location and the date of First Eucharist if received.

Reconciliation?

Please note the location and the date of First Reconciliation if received.

Confirmation?

Please note the location and the date of Confirmation if received.

General Information

If you need to add additional members of your family please fill out another form.

Information you would like us to know about you and your family

Characters remaining:
(ie just moved, switching Churches, coming back, child(ren) registered for Religious Education etc)

Would you like any of the following to be sent to you?

	Weekly Offertory Envelopes
	Monthly Pledge
	Quarterly Pledge

	Semi-Annual Pledge
	Annual Pledge

Where did you hear about St. Mary's Parish?