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Parish Registration

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- Family Last Name REQUIRED Please fill out this field. Please enter valid data.
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  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Email REQUIRED Please fill out this field. Please enter an email address.
- Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
- Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  If selected "other" above: Please enter valid data.
  
  Occupation Please enter valid data.
  
  Marriage
  
  Date of Marriage Please enter valid data.
  
  Baptism REQUIRED Yes No Please fill out this field.
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion REQUIRED Yes No Please fill out this field.
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation REQUIRED Yes No Please fill out this field.
  
  If "Yes", Provide Date: Please enter valid data.
- Spouse [if any]
  
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  Maiden Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
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  Occupation Please enter valid data.
  
  Marriage
  
  Date of Marriage Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Dependent Children (Oldest to Youngest)
  
  Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
  If selected "other" above: Please enter valid data.
  
  Gender Male Female
  
  Currently Receiving Religious Education
  
  Current Grade Level Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Child/Other Member
  
  Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
  If selected "other" above: Please enter valid data.
  
  Gender Male Female
  
  Currently Receiving Religious Education
  
  Current Grade Level Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Child/Other Member
  
  Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
  If selected "other" above: Please enter valid data.
  
  Gender Male Female
  
  Currently Receiving Religious Education
  
  Current Grade Level Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Child/Other Member
  
  Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
  If selected "other" above: Please enter valid data.
  
  Gender Male Female
  
  Currently Receiving Religious Education
  
  Current Grade Level Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Child/Other Member
  
  Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
  If selected "other" above: Please enter valid data.
  
  Gender Male Female
  
  Currently Receiving Religious Education
  
  Current Grade Level Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Other Adults In Home
  
  Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion
  
  If selected "other" above: Please enter valid data.
  
  Gender Male Female
  
  Occupation Please enter valid data.
  
  Marriage
  
  Date of Marriage Please enter valid data.
  
  Baptism Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  First Communion Yes No
  
  If "Yes", Provide Date: Please enter valid data.
  
  Confirmation Yes No
  
  If "Yes", Provide Date: Please enter valid data.
- Other Information
  
  I wish to discuss with a priest regarding:
  
  I am interested in the following: Sacramental Instruction R.C.I.A Program Religious Education Volunteer Opportunities Youth Activities Retreats Becoming a Lector Becoming a Eucharistic Minister Other
  
  If you selected "Other" above:
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St. Anthony
of Padua

1004 Magnusson, PO Box 900,
Palacios, TX 77465

Parish Registration