Parishioner Registration

PARISHIONER REGISTRATION

Please fill out this form and bring or mail it to Immaculate Conception Parish, 489 Broadway, Everett, MA 02149.

Family Last Name:______

Spouse:______Spouse:______

How would you like your mail to be addressed? ___Mr./Mrs. ___Mr. ___Mrs. ___Miss ___Other______

Street Address:______

Mailing Address (if different)______

City:______State:______Zip:______

Home Phone:______Listed:______Unlisted:______

E-mail Address:______

If you would like to participate in any parish ministries, please specify which ministry: ______

Marital Status: ___Church married ___Married ___Single ___Divorced ___Separated ___Widowed

Date and Church of marriage:______

SELF SPOUSE CHILD CHILD CHILD First Name Last/Maiden Name or Nick Name Religion Occupation Education Gender Date of Birth Date Date Date Date Date Baptism Yes No Yes No Yes No Yes No Yes No Date Date Date Date Date Reconciliation Yes No Yes No Yes No Yes No Yes No Date Date Date Date Date 1st Communion Yes No Yes No Yes No Yes No Yes No Date Date Date Date Date Confirmation Yes No Yes No Yes No Yes No Yes No List Special Needs If Any

If more space needed for Family, please add on reverse side.

Would You Like Weekly Envelopes? ___Yes ___No FAITH FORMATION REGISTRATION