Parish Registration

Family Information

Last Name REQUIRED Please fill out this field. Please enter valid data.

Family Email REQUIRED Please fill out this field. Please enter an email address.

Home Phone Please enter a phone number.

Emergency Phone REQUIRED Please fill out this field. Please enter a phone number.

Address Information

Street Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Country REQUIRED Please fill out this field. Please enter valid data.

Is this address a Winter residence? REQUIRED Yes No Please fill out this field.

Valid from (month to month) Please enter valid data.

Secondary Address

Street Address Please enter valid data.
City Please enter valid data.

State

Zip Please enter a zip code.
Country Please enter valid data.

Contribution Options REQUIRED Online Giving Envelopes None Please fill out this field.

Head of Household

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Maiden Name Please enter valid data.

Gender

Date of Birth REQUIRED

MM/DD/YYYY

Please fill out this field. Please enter a date.

Birth Place Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Cell Phone REQUIRED Please fill out this field. Please enter a phone number.

Marital Status REQUIRED Single Married Widowed Divorced Please fill out this field.

Sacramental Information

Religion REQUIRED Please fill out this field. Please enter valid data.

Sacraments Received

Please select all that apply

Baptism First Eucharist Confirmation Catholic Marriage

Spouse (if applicable)

First Name Please enter valid data.

Last Name Please enter valid data.

Maiden Name Please enter valid data.

Gender

Date of Birth

MM/DD/YYYY

Please enter a date.

Birth Place Please enter valid data.

Email Please enter an email address.

Cell Phone Please enter a phone number.

Marital Status Single Married Widowed Divorced

Sacramental Information

Religion Please enter valid data.

Sacraments Received

Please select all that apply

Baptism First Eucharist Confirmation Catholic Marriage

How did you hear about us? REQUIRED Please fill out this field. Please enter valid data.

Are you interested in volunteering at St. Mark Parish? Liturgical Ministries Religious Education Facilities Stewardship Contact me with more information, please

Comments / Requests