New Members

Christ the King New Member Registration

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

Are you transferring parishes? Yes No

If yes, please list the parish name, city & diocese Please enter valid data.

Head(s) of Household (Please List Separately)

Title Mr. Miss Mrs. Ms. Dr.

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

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

Maiden Name (if applicable) Please enter valid data.

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

Apt./Unit Number 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.

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

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

Date of Birth REQUIRED Please fill out this field. Please enter valid data.

Religion (ex. Catholic) Please enter valid data.

Marital Status REQUIRED Single Engaged Catholic Marriage Civil Marriage Separated Divorced Annulled Widowed Please fill out this field.

Date of Marriage Please enter valid data.

Place of Employment Please enter valid data.

Spouse

Title Mr. Miss Mrs. Ms. Dr.

First Name Please enter valid data.

Last Name Please enter valid data.

Maiden Name (if applicable) Please enter valid data.

Date of Birth Please enter valid data.

Email Please enter an email address.

Phone Number Please enter a phone number.

Marital Status Single Engaged Catholic Marriage Civil Marriage Separated Divorced Annulled Widowed

Place of Employment Please enter valid data.

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Date of Birth Please enter valid data.

Religion Please enter valid data.

Sacraments Received (check all that apply) Baptism Confirmation

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Date of Birth Please enter valid data.

Religion Please enter valid data.

Sacraments Received (check all that apply) Baptism Confirmation

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Date of Birth Please enter valid data.

Religion Please enter valid data.

Sacraments Received (check all that apply) Baptism Confirmation

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Date of Birth Please enter valid data.

Religion Please enter valid data.

Sacraments Received (check all that apply) Baptism Confirmation

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Date of Birth Please enter valid data.

Religion Please enter valid data.

Sacraments Received (check all that apply) Baptism Confirmation

DEPENDENT

First Name Please enter valid data.

Last Name Please enter valid data.

Gender Male Female

Date of Birth Please enter valid data.

Religion Please enter valid data.

Sacraments Received (check all that apply) Baptism Confirmation

If you have more dependents than spaces available on this form please contact the parish office at 663-8842.

Would you like to receive tithing envelopes? Yes No

If no, please fill out the Authorization for ACH Contributions form at the top of this page and return to the parish office.