Register as a Parish Member

Family ID# (for office use) Please enter valid data.

Name of previous parish? (please include City and State) Please enter valid data.

Resident Status REQUIRED Seasonal Permanent Please fill out this field.

Salutation REQUIRED Mr. Mrs. Ms. Miss Please fill out this field.

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

Maiden name (if applicable) Please enter valid data.

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

Nickname Please enter valid data.

Street 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.

Home Phone Number (with area code) REQUIRED Please fill out this field. Please enter a phone number.

My Number is Listed Unlisted

Cell Phone Number (with area code) Please enter a phone number.

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

Date of Birth (Month, Day, Year) REQUIRED Please fill out this field. Please enter valid data.

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

Gender REQUIRED Male Female Please fill out this field.

Place of Employment Please enter valid data.

Occupation Please enter valid data.

Language spoken at home REQUIRED Please fill out this field. Please enter valid data.

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

Sacraments I have received Baptism First Holy Communion Confirmation

Interested in becoming Catholic? REQUIRED Yes No N/A Please fill out this field.

Marital Status REQUIRED Single Married Separated Divorced Widowed Please fill out this field.

If divorced, have you been granted a Church Annulment? Yes No N/A

Date of Marriage Please enter valid data.

Were you married In a Catholic Church In another faith Civil Ceremony

Church of Marriage Please enter valid data.

Place of marriage (City & State) Please enter valid data.

If you were not married in the Catholic Church, would you like one of our staff to contact you about having your marriage blessed in the Catholic Church? Yes No N/A

I would like to speak with someone about the following: Baptism Communion for the Sick/Homebound Ministries (specify below) Wedding/Annulment Faith Formation Other

Please specify which ministry you would like more information or other area from above

Children living at home:

Spouse/Significant Other Information:

Child 1:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 2:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 3:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 4:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 5:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 6:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 7:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Child 8:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
School and Grade Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Will this child participate in our Faith Formation programs? Yes No
If yes, please fill out Faith Formation registration separately.

Other adults living in the home who are not registered in the parish:

Adult 1:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
Relationship Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Special Needs Please enter valid data.

Adult 2:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
Relationship Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Special Needs Please enter valid data.

Adult 3:

Name (Include last name if different) Please enter valid data.
Date of Birth (Month, Day, Year) Please enter valid data.
Gender Male Female
Relationship Please enter valid data.
Sacraments received Baptism First Holy Communion Confirmation
Special Needs Please enter valid data.

Our Lady of the Rosary

Land O' Lakes · Florida

Register as a Parish Member

Click here to download registration en Español