Please fill out this form as completely as possible. This information is for our own use and will also be forwarded to the Diocese of Columbus Census Office.

Family Name:

Address:

City:

State:

Postal Code:

E-mail address:

Phone:

Family Member Information:

Name (first, middle initial, last)

Nickname (what you prefer to be called):

Marital Status

Date of Marriage

Place of Marriage

Date of Birth

Catholic? yes no

Baptized? yes no

Made 1st Communion? yes no

Confirmed? yes no

Valid Marriage? yes no

Religion (if not Catholic)

Occupation

Employer Name

Female Adult:

Name (first, middle initial, maiden name)

Nickname (what you prefer to be called):

Marital Status

Date of Marriage

Place of Marriage

Date of Birth

Catholic? yes no

Baptized? yes no

Made 1st Communion? yes no

Confirmed? yes no

Valid Marriage? yes no

Religion (if not Catholic)

Occupation

Employer Name

Children under age 20:

Name

Date of Birth

Catholic? yes no

Baptized? yes no

Made 1st Communion? yes no

Confirmed? yes no

School Name

Grade

Child Two:

Name

Date of Birth

Catholic? yes no

Baptized? yes no

Made 1st Communion? yes no

Confirmed? yes no

School Name

Grade

Additional Children (Please enter the following information for each child):
Name: Date of Birth: Catholic?: Baptized?: 1st Communion?: Confirmed?: School Name: Grade:

Previous Parish registered in or attended regularly:

Date of Marriage

Place of Marriage

Would you like to receive The Catholic TImes, a weekly diocesan newspaper? Yes No