Our lady of grace membership form



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OUR LADY OF GRACE MEMBERSHIP FORM

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Last Name of Family_________________________________________________ Office Use Only: Number______________________Date______________________________

Email Address______________________________________________________ Home Phone__________________________Alternate Phone________________________

Street Address___________________________________________________________________City_______________________________, PA Zip Code________________

FIRST_NAME_AND_MIDDLE_INITIALS'>ADULTS

FIRST NAME AND MIDDLE INITIALS

(beyond high school)

If family name differs from above, add below


MAIDEN NAME

If Applicable



RELATIONSHIP

Husband/Father

Wife/Mother

Only Resident

Adult Son

Adult Daughter

Grandparent

Other Adult



BIRTH DATE

e.g.


3/10/60

GENDER

M/F


RELIGION

Catholic/ other




BAPTIZED

Catholic/

other/no


BAPTISM

Date


(if known)

FIRST

COMM

Yes/


No

CONFIMED

Yes/


No/

Convert


MARITAL

SATUS

By Priest

By Other

Single


Widowed

Separated

Divorced


MARRIAGE

DATE

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3.





































CHILDREN

FIRST NAME AND MIDDLE INITIALS

(high school or youngerl)

If family name differs from above, add below



RELATIONSHIP

Son/Daughter



BIRTH DATE

e.g.


3/10/60

GENDER

M/F


RELIGION

Catholic/ Other



BAPTIZED

Catholic/

Other/No


BAPTISM

DATE

(if known)



FIRST

COMM

Yes/


No

CONFIRMED

Yes/


No/


RELIGIOUS EDUCATION

Catholic School/CCD



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