Parish Registration

Thanks for taking a moment to register your household's information with our parish's office. Please fill out the form as completely as possible and then click submit.

Name of Husband
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If you're not married / single, you can simply put your name in one blank and leave the other open.
Husband's Birthday //
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Name of Wife
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Wife's Birthday //
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First and Last Name(s) of Other Adult(s) in Household
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First and Last Names of Child(ren) in Household
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Primary Phone --
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Secondary Phone --
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Email Address
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Alternative Email Address
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Home Address
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Other Preferred Means of Communication? Please list here.
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Is this information:
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Registered at ICC Before?
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Check here if you have been registered at Immaculate Conception Church in the past.
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