Our lady of grace membership form

OUR LADY OF GRACE MEMBERSHIP FORM

Please print

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

1.

2.

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

1.

2.

3.

4.