Parishioner Registration

Family Name

Address

City, State, Zip Code

Phone: (Please indicate if Home [H], Cell [C], or Work [W].

Email:

Head(s) of Household

Other Adults

Children

Are you interested in making my weekly contribution via automatic bank withdrawal?

Yes

No

Not at the moment, but I would like more information.

If your primary language spoken at home is not listed above, please indicate here:

Primary language spoken at home:

English

Español

Other

Would you like to receive donation envelopes?

Yes

No