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Holy Rosary Parish Registration Form
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- I am registering as a parishioner for... REQUIRED Holy Rosary - Rosenberg St. Wenceslaus - Beasley Please fill out this field.
- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Mailing 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.
- Physical Address
  Only provided if different from mailing address.
  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.
- Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mass Attendance
  
  Martial Status
  
  Date of Marriage, if applicable Please enter a date.
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
- Spouse, If applicable
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Maiden Name Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mass Attendance
  
  Martial Status
  
  Date of Marriage, if applicable Please enter a date.
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
- Number of Additional Adult(s) in Household REQUIRED Please fill out this field.
  
  Additional Adult 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mass Attendance
  
  Marital Status
  
  Date of Marriage, if applicable Please enter a date.
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Additional Adult 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mass Attendance
  
  Marital Status
  
  Date of Marriage, if applicable Please enter a date.
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Additional Adult 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mass Attendance
  
  Marital Status
  
  Date of Marriage, if applicable Please enter a date.
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Additional Adult 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth Please enter a date.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Mass Attendance
  
  Marital Status
  
  Date of Marriage, if applicable Please enter a date.
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
- Number of Child(ren) in the Household REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
  
  Child 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Nickname Please enter valid data.
  
  Sex
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Mass Attendance
  
  Religion
  
  Special Situation(s) Blind Deaf Mental Disability Physical Disability Homebound
  
  Language English Spanish Vietnamese Other
  
  Received the Sacrament of Baptism? Yes No
  
  Received the Sacrament of First Penance and Reconciliation? Yes No
  
  Received the Sacrament of the Eucharist? Yes No
  
  Received the Sacrament of Confirmation? Yes No
  
  Current Grade Level
  
  School Name Please enter valid data.
  
  Attends Faith Formation? Yes No
- Do you desire offering envelopes? REQUIRED Yes No Please fill out this field.
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HOLY ROSARY PARISH

HOLY ROSARY CATHOLIC CHURCH & SCHOOL | ST. WENCESLAUS MISSION

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