Name *

First Name

Last Name

Contact Phone *

(###)

###

####

Mailing Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Present Status *

I am presently a practicing Catholic in good standing in the Church

I am Catholic but I am not presently in good standing with the Church

I was baptized Catholic but I am presently a member of another religious community

I am not Catholic

Sacramental History

Please check all that apply

I was Baptized as an infant

I was Confirmed as a teenager

I was Baptized & Confirmed as an adult (through RCIA or Private Instruction)

I have received First Holy Communion

I have made my First Holy Confession

I am married (in the Church)

I am married (outside the Church)