STPCICP Parishioner Form for Offline Mass Preparation (Pre-Registration Form)

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This is NOT a booking form for Offline/Physical Mass.

This is a one time data collection form for all Catholic Expatriate/Foreigner who have stayed at least 3 months (quasi-domicile) in the Greater Jakarta area. Once we have your details we will send you invitation email for the following Sunday Mass.

For health & safety reasons, the Archdiocese of Jakarta allows 75% maximum of the regular Church capacity; until further notice. Therefore Mass Booking is still important, you will find the Mass Booking Form in the email we send every week.

Please fill in the form carefully and submit one form for each individual in the family. All information will be treated with respect and kept confidential.

THANK YOU & GOD BLESS US ALL.

Email *

Full Name (based on I.D.) *

Nickname:

Date of Birth: *

YYYY

Place of birth; city, country

Nationality : *

I.D. - 1. Country of Passport *

Please state the country that issued your passport

I.D. - 2. Passport Number *

I.D. - 3. Passport Expiry Date *

YYYY

Active Mobile Phone Number: *

Current Residing Address: (Please provide your complete/detail home address incl. street, number, area (kelurahan). Incomplete address will not be processed) *

Current home address postal code (for example: St. Theresia Church is 10350) *

Select where your residential area located: *

ATTENTION: Once you submit this form, the information will be used to evaluate your eligibility to attend the physical Mass. IF you are invited, are you ready to come to the physical Mass? Your answer will be used to follow up with you in the future.

YES

MAYBE

Would you like to receive news, update or information from St, Peter Canisius International Catholic Parish Jakarta? *

YES, please send to my email

YES, please send to my WhatsApp number

NO, THANK YOU

Required

You are : *

Catholic

Non-Catholic

Have you been vaccinated? *

I have taken my 1st dose/shot of Covid-19 Vaccination

I have completed both doses/shots of Covid-19 Vaccination

Not yet taken the Covid-19 Vaccination

Required

Send me a copy of my responses.

Submit

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