St. John XXIII Catholic Community Parishioner Registration
ONLINE REGISTRATION FORM

Welcome!  Thank you for your interest in joining our faith community!
For more information, please view our website at www.johnxxiiicc.org.

Please be sure to fill out this registration form to the best of your knowledge. You may use this to complete a new registration or to update your existing record.

If you decide not to register online, you may fill out a hardcopy registration form at our Main Office.
The office is open Monday-Thursday from 9:00AM- 5:00PM and Friday from 9:00AM-12:00PM.

Your information is handled with the strictest confidence. Your name, address, and listed phone number is the only information provided to the Parish Committee representatives. If you do not wish to be contacted by anyone on a Parish Committee by phone, please indicate that by selecting 'do not contact' under your phone number. Please note it is important to keep your family information updated. If an emergency were ever to occur, the information is available to the Priest who may need it to locate your loved ones. The Welcome Committee will be mailing you an information packet. The packet contains information on all our committees and ministries available for you to participate in.
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Is this a new registration or are you updating your existing record? *
Head of Household Last Name *
Head of Household First and Middle Name *
Head of Household Title *
Head of Household Suffix and/or Title not listed above
Head of Household Nickname Name
Head of Household's Email Address *
name@domain.com  (If you do not have one, please enter "none.")  This email address will be the default addressed used to contact your family.
Home Phone Number *
(XXX-XXX-XXXX)
Do you want your home phone number listed, unlisted, or 'do not contact'? *
Emergency Phone Number *
(XXX-XXX-XXXX)
Do you want your emergency phone number listed, unlisted, or 'do not contact'? *
Mailing Address *
(Street, Apartment #)
City, State, Zip *
Street Address if Different From Above
(Street, Apartment #; City, State, Zip)
Name of Parish at which previously registered *
If never registered at a parish enter "none."
Are you currently registered under your parents at any parish? *
If you replied "yes" to the previous question, please enter your parents' name(s) (first and last) as well as the parish in which you are registered.
parent name, parent's parish of registration
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