Census Form

Please complete this form in its entirety. Information is requested for ALL members who live in the household at the address shown. Please complete all boxes that apply to each member. This form may be filled out online OR printed, filled out and returned to the parish office or in the collection basket at any weekend Mass. A SPECIAL NOTE: If there is a child over the age of eighteen who is living with you, he or she is encouraged to complete a census form of their own. If you have a dependent child attending college out of town, pleas inform the parish secretary of their current mailing and e-mail addresses so that we can keep them informed of activities in the parish, especially those involving young adults.

                                                                                                                                                                                  Date:

Members

Title Select Mr. Mrs. Ms. Miss Dr. Rev.      Family (Last) Name          Suffix Select Sr. Jr. II III MD Ph.D.           First Name          

Maiden Name (If applicable)         Family Position Select Head of the household Mother Father Stepfather Stepmother Son Daughter Spouse Uncle Aunt Grandmother Grandfather Grandson Granddaughter        Birth date 

Street Address               City            ZIP 

Occupation          Employer 

E-mail Address                                     Phone Number    Select Listed Unlisted    

Cell Phone     Marital Status   Select Single Married      Marriage Date (if applicable)        Religion        Select Catholic Non-Catholic Non-Christian

Dates of each:    Baptism   Select Yes No            1st Communion         Confirmation

If married, were you married according to the rites of the Catholic Church?  Select Yes No               Please indicate your gender Select Female Male

Please indicate language(s) spoken: 1st Language           2nd Language

Is there anyone in this household who is disabled or homebound? Select No Yes

Ministries/Organizations you are presently involved

Ministries/Organizations you are interested in joining
 

Spouse

Title Select Mr. Mrs. Ms. Miss Dr. Rev.          Spouse's Name          Suffix Select Sr. Jr. II III MD Ph.D.     

Maiden Name (if applicable)           Family Position Select Head of the household Mother Father Stepfather Stepmother Son Daughter Spouse Uncle Aunt Grandmother Grandfather Grandson Granddaughter      

Date of Birth                 Religion Select Catholic Non-Catholic Non-Christian

Email Address             Phone Number             Cell Phone    

Occupation          Employer 

Dates of each:     Baptism            1st Communion             Confirmation

Please indicate your gender Select Female Male

Please indicate language(s) spoken:     1st Language               2nd Language

Ministries/Organizations you are presently involved

Ministries/Organizations you are interested in joining

Children

Ministries children are interested in: