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Sacred Heart Church

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* Indicates required field

Family's Last Name *

Wife's Maiden Name *

Address *

City/Town *

Zip Code *

Phone Number *

Additional Phone/Cell *

Additional Email *

Email *

Family (or Individual) Status *

Single Married Separated Divorced Widow Widower

Family Members

Family Member 1 (Adult) First/Last *

Choose One *

Male Female N/A

D.O.B. Example: 10/03/1985 *

Sacraments Received *

Baptism 1st Eucharist Confirmation

Occupation/Hobbies *

Family Member 2 (ADULT) First/last (optional) *

Choose One *

Male Female N/A

D.O.B. EXAMPLE: 10/03/1985 *

Sacraments Received *

Baptism 1st Eucharist Confirmation

Occupation/Hobbies *

Children

(if none, scroll to bottom and select "register now")

CHILD #1 (OPTIONAL) FIRST/LAST NAME *

Choose One *

Male Female N/A

D.O.B. Example: 10/03/1985 *

Catholic Sacraments Received *

Baptism 1st Eucharist Confirmation

CHILD #2 (OPTIONAL) FIRST/LAST NAME *

Choose One *

Male Female N/A

D.O.B. Example: 10/03/1985 *

Catholic Sacraments Received *

Baptism 1st Eucharist Confirmation

CHILD #3 (OPTIONAL) FIRST/LAST NAME *

Choose One *

Male Female N/A

D.O.B. Example: 10/03/1985 *

Catholic Sacraments Received *

Baptism 1st Eucharist Confirmation

Submit

[to add additional children, please select "register now" and submit a second form.]

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