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Parish Registration

- Pastorate Central

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- Family Name: REQUIRED Please fill out this field. Please enter valid data.
- Address: REQUIRED Please fill out this field. Please enter valid data.
- City/State/Zip: REQUIRED Please fill out this field. Please enter valid data.
- Home Phone: Please enter valid data.
- Name of Parish you are joining: St. Patrick, Colesburg St. Mark, Edgewood St. Joseph, Elkader St. Mary, Strawberry Point Sacred Heart, Volga
- Adult 1 Information
- First/Middle/Last Name: REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name: Please enter valid data.
- Cell Phone: Please enter valid data.
- Email Address: Please enter valid data.
- Birth Date: Please enter valid data.
- Birth Place: Please enter valid data.
- Baptism Date: Please enter valid data.
- Baptism Place: Please enter valid data.
- Marital Status: Please enter valid data.
- Marriage Date: Please enter valid data.
- Marriage Place: Please enter valid data.
- Occupation/Employer: Please enter valid data.
- Adult 2 Information
- First/Middle/Last Name: Please enter valid data.
- Maiden Name: Please enter valid data.
- Cell Phone: Please enter valid data.
- Email Address: Please enter valid data.
- Birth Date: Please enter valid data.
- Birth Place: Please enter valid data.
- Baptism Date: Please enter valid data.
- Baptism Place: Please enter valid data.
- Marital Status: Please enter valid data.
- Marriage Date: Please enter valid data.
- Marriage Place: Please enter valid data.
- Occupation/Employer: Please enter valid data.
- How many children do you have? REQUIRED Please fill out this field.
  
  Child 1
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 2
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 3
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 4
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 5
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 6
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 7
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
  
  Child 8
  
  First/Middle/Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Place of Birth Please enter valid data.
  
  Baptism Date and Location Please enter valid data.
  
  First Communion and Location Please enter valid data.
  
  Confirmation and Location Please enter valid data.
Submit

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