Our Lady of Lourdes Parish Registration

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Welcome to our parish! We are so happy to have you join us in community. Please fill out this form completely so we can better serve you.

Last Name *

Head of Household First Name: *

Title *

Mrs

Other

Suffix:

III

Other

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Home Phone Number: *

May we list your phone number? *

Listed

Unlisted

Cell Number *

Street Address (complete with city, state, and zip) *

E-Mail Address *

Today's Date *

YYYY

Are you interested in online giving? *

Yes

Do you want to receive envelopes? *

Yes

Were you previously registered in another parish in the Diocese of Richmond? If so, please list prior parish: *

Marital Status *

Married

Single

Divorced

Separated

Widowed

Engaged

If Married, Date of Marriage:

YYYY

If Married, Married Catholic?

Yes

Validated Catholic Marriage

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Household Members

We'd like to learn more about the members of your household. Please fill out the information for each family member. When you have completed your family, skip to the end.

Family Member One (Head of Household): (First, Middle, Last)

Family Member One: Gender

Female

Male

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Family Member One: Religion *

If other, Family Member One Religion

Language Spoken of Family Member One:

Race of Family Member One

Date of Birth of Family Member One

Family Member One: Name and Address of Church of Baptism *

Family Member One: First Holy Communion Name and Address of Church

Family Member One: Confirmation Name and Address of Church

Family Member Two: Name: (First, Middle, Last)

Family Member Two: Gender:

Female

Male

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Family Member Two: Religion:

Catholic

Other

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If other, Family Member Two: Religion (please list):

Language Spoken of Family Member Two:

Race of Family Member Two:

Date of Birth of Family Member Two:

YYYY

Family Member Two: Name and Address of Church of Baptism

Family Member Two: Name and address of First Holy Communion

Family Member Two: Name and address of Confirmation

Family Member 3: (First, Middle, Last)

Family Member 3: Gender

Male

Female

Clear selection

Family Member 3: Grade and School (If applicable)

Family Member 3: Religion:

Catholic

Other:

Clear selection

Family Member 3: Language Spoken

Family Member 3: Race

Family Member 3: Date of Birth

YYYY

Family Member 3: Name and Location of Church of Baptism

Family Member 3: Name and Location of Church of First Holy Communion

Family Member 3: Name and Location of Confirmation

Family Member 4: (First, Middle, Last)

Family Member 4: Gender

Male

Female

Clear selection

Family Member 4: Grade and School (If applicable)

Family Member 4: Religion:

Catholic

Other:

Clear selection

Family Member 4: Language Spoken

Family Member 4: Race

Family Member 4: Date of Birth

YYYY

Family Member 4: Name and Location of Church of Baptism

Family Member 4: Name and Location of Church of First Holy Communion

Family Member 4: Name and Location of Confirmation

Family Member 5: (First, Middle, Last)

Family Member 5: Gender

Male

Female

Clear selection

Family Member 5: Grade and School (If applicable)

Family Member 5: Religion:

Catholic

Other:

Clear selection

Family Member 5: Language Spoken

Family Member 5: Race

Family Member 5: Date of Birth

YYYY

Family Member 5: Name and Location of Church of Baptism

Family Member 5: Name and Location of Church of First Holy Communion

Family Member 5: Name and Location of Confirmation

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