St. Therese Catholic Church REGISTRATION FORM CONFIDENTIAL Welcome to St. Therese Parish!

Please take a few moments to fill out this form:
(If you are making changes to an existing REGISTRATION,
type your Parishioner Number in this box: .
Fill in the four boxes marked with an asterisk (*)
and ONLY the boxes that need information changes.
After you are done, click on the "Submit the Form" button at the bottom.)


*Today’s Date:

*FAMILY NAME: EMAIL ADDRESS: STREET ADDRESS: APT. NO. CITY: STATE: ZIP: HOME PHONE: WORK PHONE: CELL PHONE: IS THERE ANY TYPE OF GROUP OR MINISTRY IN WHICH YOU MAY BE INTERESTED IN PARTICIPATING? *NAME OF HEAD of HOUSEHOLD: (First Name, Middle Init.) BIRTH DATE: OCCUPATION: RELIGION: SACRAMENTS RECEIVED: Baptism 1st Communion Confirmation NAME of SPOUSE: (First Name, Middle Init.) BIRTH DATE: OCCUPATION: RELIGION: SACRAMENTS RECEIVED: Baptism 1st Communion Confirmation CHILDREN, INCLUDE LAST NAME, IF DIFFERENT. INCLUDE SACRAMENTS EACH CHILD HAS RECEIVED: I CAN MOSTLY OFTEN BE REACHED VIA: Home Phone Work Phone Cell Phone *SUBMITTED BY: Thank you for your time and your participation.

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