Parish Registration

Date Registered (Today's Date) REQUIRED Please fill out this field. Please enter a date.

Which Parish will you be registering with? REQUIRED Cathedral of St. Raphael St. Patrick Church Please fill out this field.

Contact Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Primary Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Mobile Phone Number Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Birthdate REQUIRED Please fill out this field. Please enter valid data.

Occupation Please enter valid data.

Place of Employment Please enter valid data.

Which Mass time will you most likely attend?

What inspired you to register with our parish?

Religion

Received the following Sacraments: Baptism 1st Communion Confirmation

Marital Status REQUIRED Please fill out this field.

Spouse's Information (If Applicable)

Children (If Applicable)

Would you like to receive envelopes? REQUIRED Yes No Please fill out this field.

Would you like to participate in Online Giving (EFT)? REQUIRED Yes No Please fill out this field.

Would you like to learn more about how to get involved in our parishes? REQUIRED Yes No Please fill out this field.

General Comments or Questions