Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of Birth *

MM

DD

YYYY

Please indicate any Sacraments you have already completed: *

Certificates for completed sacraments are considered legal documents within the Church. Because of this, we need to ensure our records are aligned with all others. You will need to provide the certificate for each completed sacrament. If spelling is unclear you may have to provide your birth certificate.

Baptism

First Reconciliation

First Communion

Confirmation

Are you currently married by civil court or by another faith? *

Yes

No

I understand the responsibilities above and am committed to fulfilling them. *

Yes

No

Emergency Contact Name *

First Name

Last Name

Emergency Contact Phone *

(###)

###

####

Immaculate Heart of Mary Catholic Church can occasionally use photos of me to promote the Faith Formation program and other church activities. Uses might include a display board, church newsletter, church website, social media, press releases, etc. No names will be used on the website, in social media, or in press releases without your consent. Do you give Immaculate Heart of Mary Catholic Church permission to include you in photos used for the purposes stated above? *

Yes, I give permission.

No, I do not give permission.