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Head of Household Information

Head of Household Full Name REQUIRED Please fill out this field. Please enter valid data.

Head of Household Nickname Please enter valid data.

Head of Household Maiden (if applicable) Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Head of Household Date of Birth REQUIRED Please fill out this field. Please enter a date.

Head of Household Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Head of Household Email REQUIRED Please fill out this field. Please enter an email address.

Head of Household Occupation Please enter valid data.

Emergency Contact Name/Relationship Please enter valid data.

Emergency Contact Phone Number Please enter a phone number.

Giving preference REQUIRED Please fill out this field.

Head of Household Baptized? Yes No

Head of Household First Eucharist? Yes No

Head of Household Confirmed? Yes No

Marital Status Single Married (witnessed by Priest or Deacon) Married (outside the Church) Widowed Separated Divorced

Date of Marriage Please enter valid data.

Church and City, State, Zip Code of Marriage Please enter valid data.

Spouse Information

Spouse Full Name REQUIRED Please fill out this field. Please enter valid data.

Spouse Nickname Please enter valid data.

Spouse Maiden Name (if applicable) Please enter valid data.

Spouse Date of Birth Please enter a date.

Spouse Phone Number (if different from head of household) Please enter a phone number.

Spouse Email (if different from head of household) Please enter an email address.

Spouse Occupation Please enter valid data.

Spouse Baptized? Yes No

Spouse First Eucharist? Yes No

Spouse Confirmed? Yes No

Marital Status Single Married (witnessed by Priest or Deacon) Married (outside the Church) Widowed Separated Divorced

Dependant Child (Under Age 18 only -- adult children should register independently)

Child's Full Name Please enter valid data.

Gender Male Female

Child's Date of Birth Please enter a date.

Child's Date of Baptism Please enter a date.

Church and City, State of Child's Baptism Please enter valid data.

Child's Other Sacraments Reconciliation First Eucharist Confirmation

Dependant Child (Under Age 18 only -- adult children should register independently)

Child's Full Name Please enter valid data.

Gender Male Female

Child's Date of Birth Please enter a date.

Child's Date of Baptism Please enter a date.

Church and City, State of Child's Baptism Please enter valid data.

Child's Other Sacraments Reconciliation First Eucharist Confirmation

Dependant Child (Under Age 18 only -- adult children should register independently)

Child's Full Name Please enter valid data.

Gender Male Female

Child's Date of Birth Please enter a date.

Child's Date of Baptism Please enter a date.

Church and City, State of Child's Baptism Please enter valid data.

Child's Other Sacraments Reconciliation First Eucharist Confirmation

More than three children? Please use the text box below to list their names, gender, birth date, date of baptism, church and city/state of baptism, and any other sacraments received to date.

I/we would like to get involved! I/we would like information about:

Perhapsl you have a special skill or talent that would be helpful to the parish! Please mention it in the box below!

Need/Availability for Appointment

Please mention any concerns or topics you would like to discuss, or any special skills/talents you wish to share! REQUIRED Please fill out this field.

St. Mary of the Falls

Roman Catholic Parish in Olmsted Falls, OH

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