Membership Registration Form/updated Parishioner Information Form

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St. Michael Catholic Church
Membership Registration Form/Updated Parishioner Information Form
New Members please fill out for each member of the household
(Please include those who are not Catholic)
FAMILY MEMBER TYPE:
HEAD OF HOUSEHOLD
SPOUSE
SON
DAUGHTER
OTHER ________________ (List relationship)
FAMILY NAME: LAST:____________________________
MIDDLE:_________________________
FIRST:___________________________
PREFERRED NAME:________________
MAIDEN:_________________________
TITLE: MR./MRS./MS./MISS/DR.______
DATE OF BIRTH:
_____________________
ADDRESS:
______________________________________
______________________________________
CITY:______________________________
STATE:__________
ZIP:____________________
EMAIL:___________________________________________
TELEPHONE: HOME:_________________
UNLISTED
WORK:_____________ EXT. ____ CELL:_______________
EMERGENCY CONTACT:____________________________
EMERGENCY PHONE:______________________
OCCUPATION:____________________________________
EMPLOYER:______________________________
STUDENT:
SCHOOL__________________________ GRADE _______________
MARITAL STATUS: ______Married
By a Priest ____ Yes _____No
______Divorced
Annulment _____Yes ____No
______Single
______Separated
______Widowed
PERSONAL INFO:
______Male
______Female
MEMBER STATUS:
______Active
______Inactive
______Other religion
SHUT-IN: _____Yes _____No
ATTEND PSR CLASSES ____YES ____NO

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