Please Circle Parish for Registration Holy Angels Resurrection St. Mary St.

Paul

Date: ______________________
Cluster Parishes of Portsmouth & Chesapeake
Please fill out front and back of form completely and print neatly so that we may better serve you.

Are You Currently Registered in a Parish in the Diocese of Richmond? Y / N If so, which one?_________________________________________
Information for First Head of Household: Catholic: Y / N (Circle)

Marital Status (circle): Single Mar r ied Widowed Separated Divorced

Please Circle: Dr. Mr. Mrs. Ms. Miss

Name:________________________________________________________
First Last Maiden (If Applicable)

Street Address:________________________________________________

City:_______________________ State:______ Zip Code:___________

Do not publish my address in the Parish Directory if checked

Email:_______________________________________________________
(To be used solely for important communication from the parish)

Home Phone: (_____) _______________ Cell: (_____)_______________

Do not publish my phone number in the Parish Directory if checked


Date of Birth:____ / ____ / ______ Age:_______ Gender: M / F

Ethnicity: Asian Black Hispanic Native Amer ican White Other

Place of Employment: __________________________________________

Occupation/Former Occupation if Retired: ________________________

Primary Language:_____________ Other Languages:_______________

Please Circle Sacraments Received:

Baptism 1st Communion Confirmation Holy Orders Marriage
For Ofce Use Only:
Parish Number: ___________________________ Comments: ________________________________________________________________________________________
Information for Second Head of Household: Catholic: Y / N (Circle)

Marital Status (circle): Single Mar r ied Widowed Separated Divorced

Please Circle: Dr. Mr. Mrs. Ms. Miss

Name:________________________________________________________
First Last Maiden (If Applicable)

Street Address:________________________________________________

City:_______________________ State:______ Zip Code:___________

Do not publish my address in the Parish Directory if checked

Email:_______________________________________________________
(To be used solely for important communication from the parish)

Home Phone: (_____) _______________ Cell: (_____)_______________

Do not publish my phone number in the Parish Directory if checked


Date of Birth:____ / ____ / ______ Age:_______ Gender: M / F

Ethnicity: Asian Black Hispanic Native Amer ican White Other

Place of Employment: __________________________________________

Occupation/Former Occupation if Retired: ________________________

Primary Language:_____________ Other Languages:_______________

Please Circle Sacraments Received:

Baptism 1st Communion Confirmation Holy Orders Marriage
For married couples who are not in a sacramentally valid marriage, would you like one of our priests to contact you about having your marriage convalidated? Y / N
A sacramentally valid marriage is one that takes place within a Catholic Church, one that takes place in a non-Catholic Church with dispensation from a Bishop, or one between two non-
Catholics in another church prior to their conversion to the Catholic Faith. If your marriage falls outside of these situations, our priests would like to help you with the convalidation of
your marriage within the Catholic Church.

Information for Children Living at Home: (Children over 21 living at home should fill out their own separate parish registration form)


Are there any special circumstances or information of which the parish should be aware?
____________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________________________________________________


Are any Members of Your Family Disabled? Y / N If so, please explain who and what type of disability, so that we may better serve them.
____________________________________________________________________________________________________________________________________________________


I would like someone to contact me regarding additional information for the following (Please cir cle all that apply)

Becoming Catholic Returning Catholics Baptism Communion to the Sick/Homebound Wedding/Annulment Religious Education

Other (Please Specify):________________________________________________________________________________________________________________________________



I would like someone to contact me regarding becoming a part of a Cluster Ministry (Please cir cle all that apply)

Altar Servers (gr ades 3+) Arts & Environment Buildings, Grounds & Maintenance Catechist


Communion to the Homebound Extraordinary Minister - Communion Fellowship Funerals


Greeters Haiti Ministry Homebound/Hospital Visitation Lectors


Music (choir or instr ument) Oasis/Homeless Office Volunteer Respect Life


Ushers Vacation Bible School
Name
(Include Last if Different)
Date of Birth:
Mo/Day/Yr
Male/Female Ethnicity Baptized
(Yes or No)
1st Communion
(Yes or No)
Confirmed
(Yes or No)
School Grade

M / F Y / N Y / N Y / N

M / F Y / N Y / N Y / N

M / F Y / N Y / N Y / N

M / F Y / N Y / N Y / N

M / F Y / N Y / N Y / N