Registration/Census Form

Use this form to register, change your address within the parish or to notify the Rectory that you are moving out of the parish.

Please only Register if you are within the boundaries of the parish

Tigue Road from Rt. 52 to Rt. 202 (West Chester by-pass); to Westtown Road; to Creek Road; to Cheyney Woods Road; to dilworthtown Road; to Brintons Bridge Road (with air line across Brandywine Creek); to Street Road (Rt. 926); to Denton Hollow Road; to Rt. 52; to Tigue Road.
 

Note: Please submit the form multiple times if you have more than 2 family members. The form below has space for two individuals. For example: If a family has a mother, father and two children, the form below must be submitted twice. Once with the mother and father information and once with the children information. The household information only needs to be filled out once. On multiple submittals just enter last name in household information.

If you have children age 3 to 17 that need to be enrolled in Religious Education, please call 399-9642.

(Use the Tab key to move from field to field)

Please select choice:
Initial Registration
Change of Address Within Parish (just input Family Last Name, New Address and Family Member # 1's First Name)
Moving Out of Parish (just input Family Last Name and Family Member # 1's First Name)

Household Information

Family Last Name

Total # of Family Members

Address

City State Zip Township

Home Telephone # -- Unlisted? Yes No

Marital Status

If Married;

Church of Marriage City

State Date of Marriage

Involved in Religious Education? Yes No

Regularly attending Mass? Yes No

Do you want to receive weekly collection envelopes? Yes No

Individual Family Member Information

Family Member #

First Name Middle Name

Sex - Male Female

Date of Birth City State

Religion

Sacraments Received: (Check all that apply)
Baptism Penance 1st Communion Confirmation

Name of Father Name of Mother

Maiden Name, if applicable

Name of Godparents

Employment Information

Employer

Title

City State Work Telephone #

Education Information

School Name

Grade Level Highest Degree

Please list any special needs

Are you willing to volunteer? Yes No

Please list any special skills or talents

Family Member #

First Name Middle Name

Sex - Male Female

Date of Birth City State

Religion

Sacraments Received: (Check all that apply)
Baptism Penance 1st Communion Confirmation

Name of Father Name of Mother

Maiden Name, if applicable

Name of Godparents

Employment Information

Employer

Title

City State Work Telephone #

Education Information

School Name

Grade Level Highest Degree

Please list any special needs

Are you willing to volunteer? Yes No

Please list any special skills or talents

After submitting your information you will be instructed on your next steps. Submit more than once if more than two family members.

 

 

Date Revised: Thursday, October 29, 1998