Parish Registration - St. Mary

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(321) 636-6834

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1136 Seminole Drive, Rockledge FL 32955

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info@stmaryrockledge.org

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Parish Registration

Please complete this St. Mary Catholic Church Registration Form and return to the Pastoral Office or email to info@stmaryrockledge.org . You can also complete the online form below.

Family Information
Date*
MM slash DD slash YYYY
Family Last Name*
Current Address*
Street Address Address Line 2 City State ZIP Code
Home Phone Number*
Email Address*
Winter Resident?*
- Yes
- No
Date of Arrival
MM slash DD slash YYYY
Date of Departure
MM slash DD slash YYYY
St. Mary School Family*
- Yes
- No
Head of Household
Sex*
- Male
- Female
Name*
Prefix First Last
Marital Status*
- Married
- Single
- Divorced
- Separated
- Widowed
Date of Marriage*
MM slash DD slash YYYY
Church Name/City where married
Date of Birth*
MM slash DD slash YYYY
Language
Current Employer
Occupation
Work Phone
Cell Phone
Status
- Active Catholic
- Inactive Catholic
Sacraments Received*
Check to indicate yes
- Baptism
- Confirmation
- First Communion
Place of Baptism*
Date of Baptism
MM slash DD slash YYYY
Place of First Communion*
Date of First Communion
MM slash DD slash YYYY
Place of Confirmation*
Date of Confirmation
MM slash DD slash YYYY
Input Spouse's Information?*
- Yes
- No
Additional Members Living at Address?*
- Yes
- No
Spouse
Name*
Prefix First Last
Cell Phone
Marital Status*
- Married
- Single
- Divorced
- Separated
- Widowed
Date of Birth*
MM slash DD slash YYYY
Language
Ethnicity
Current Employer
Occupation
Religion
Status
- Active Catholic
- Inactive Catholic
Sacraments Received*
Check to indicate yes
- Baptism
- Confirmation
- First Communion
Place of Baptism*
Date of Baptism
MM slash DD slash YYYY
Place of First Communion*
Date of First Communion
MM slash DD slash YYYY
Place of Confirmation*
Date of Confirmation
MM slash DD slash YYYY
Additional Members at Address
Number of additional members*
Please enter a number from 1 to 8.
Additional Member 1
Name*
First Last
Sex*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Occupation/Grade
Employer/School
Religion
Language
Ethnicity
Sacraments Received*
Check to indicate yes
- Baptism
- Confirmation
- First Communion
Place of Baptism*
Date of Baptism*
MM slash DD slash YYYY
Place of First Communion*
Date of First Communion*
MM slash DD slash YYYY
Place of Confirmation*
Date of Confirmation*
MM slash DD slash YYYY
Additional Member 2
Name*
First Last
Sex*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Occupation/Grade
Employer/School
Religion
Language
Ethnicity
Sacraments Received*
Check to indicate yes
- Baptism
- Confirmation
- First Communion
Place of Baptism*
Date of Baptism*
MM slash DD slash YYYY
Place of First Communion*
Date of First Communion*
MM slash DD slash YYYY
Place of Confirmation*
Date of Confirmation*
MM slash DD slash YYYY
Additional Member 3
Name*
First Last
Sex*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Occupation/Grade
Employer/School
Religion
Language
Ethnicity
Sacraments Received*
Check to indicate yes
- Baptism
- Confirmation
- First Communion
Place of Baptism*
Date of Baptism*
MM slash DD slash YYYY
Place of First Communion*
Date of First Communion*
MM slash DD slash YYYY
Place of Confirmation*
Date of Confirmation*
MM slash DD slash YYYY
Additional Member 4
Name
First Last
Sex*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Occupation/Grade
Employer/School
Religion
Language
Ethnicity
Sacraments Received*
Check to indicate yes
- Baptism
- Confirmation
- First Communion
Place of Baptism*
Date of Baptism*
MM slash DD slash YYYY
Place of First Communion*
Date of First Communion*
MM slash DD slash YYYY
Place of Confirmation*
Date of Confirmation*
MM slash DD slash YYYY
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Name
This field is for validation purposes and should be left unchanged.

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1136 Seminole Drive Rockledge, FL 32955

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