Parish Registration Form - Saint Luke the Evangelist

Saint Luke the Evangelist Parish
FOR OFFICE USE
ONLY
Holy Angels Church, Plaistow
Mary, Mother of the Church, Newton
8 Atkinson Depot Road
Plaistow, NH 03865
Tel: 603-382-8324 Fax: 603-382-1113
jtremblay@stluketheevangelist.net
PLEASE PRINT:
PARISH REGISTRATION FORM
HOME PHONE
LAST NAME
Marital Status (please check one)
Married
Single
Separated
By Whom (Priest, Minister, Justice)
Member Name
WORK PHONE(S)
HOME ADDRESS
MAILING ADDRESS
(Include wife’s maiden name)
ID No.:________________
Date: _________________
Widowed
Member Status
(Head, Spouse, Child)
Divorced
Male or
Female
Divorced & Remarried
Birth Date
Cell Phone
Seeking Validation of Marriage
E-mail Address
Date of Marriage
Religion
(If not Catholic)
Please check off sacraments each family member has received with dates (if known):
Family Member
Baptism
First Eucharist
Head of House
Spouse
Child
Child
Child
Please list any additional information or family members on back.
Would you like Contribution Envelopes sent directly to your home address (Yes or No)? Circle one
First Reconciliation
Confirmation
Occupation
(Or School & Grade)