Our Lady of Lourdes Parish Registration
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.
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Last Name *
Head of Household First Name: *
Title *
Suffix:
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Home Phone Number: *
May we list your phone number? *
Cell Number *
Address Line 1 (Number and Street Name): *
City: *
State: *
Zip Code: *
E-Mail Address *
Today's Date *
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Are you interested in online giving? *
Do you want to receive envelopes? *
Were you previously registered in another parish in the Diocese of Richmond? If so, please list prior parish: *
Marital Status *
If Married, Date of Marriage:
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If Married, Married Catholic?
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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.
Head of Household: (First, Middle, Last)
Head of Household: Gender
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Head of Household: Religion *
If other, Head of Household Religion
Language Spoken of Head of Household:
Race of Head of Household
Date of Birth of Head of Household: *
Head of Household: Name and Address of Church of Baptism *
Head of Household: First Holy Communion Name and Address of Church
House of Household: Confirmation Name and Address of Church
Family Member Two:  Name: (First, Middle, Last)
Family Member Two: Gender:
Clear selection
Family Member Two: Religion:
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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:
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DD
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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
Clear selection
Family Member 3: Grade and School (If applicable)
Family Member 3: Religion:
Clear selection
Family Member 3: Language Spoken
Family Member 3: Race
Family Member 3: Date of Birth
MM
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DD
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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
Clear selection
Family Member 4: Grade and School (If applicable)
Family Member 4: Religion:
Clear selection
Family Member 4: Language Spoken
Family Member 4: Race
Family Member 4: Date of Birth
MM
/
DD
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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
Clear selection
Family Member 5: Grade and School (If applicable)
Family Member 5: Religion:
Clear selection
Family Member 5: Language Spoken
Family Member 5: Race
Family Member 5: Date of Birth
MM
/
DD
/
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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