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RCIA Registration form for inquirers

General Information

First Name:*

Middle Name:*

Last Name:*

Address:*

Address (Unit # or Floor):

City:*

County:*

State:*

Zip Code:*

Preferred Telephone Number:*

Preferred Secondary Telephone Number:*

Work Telephone Number:*

Email:

Gender:*

Date of Birth: (ex. 00/00/0000)*

Age:

Place of Birth-City:

Occupation:

Father's First and Last Name:*

Mother's First Name and Maiden Name:*

Have you been baptized?*

If so, Date of Baptism:*

Denomination:*

Name of Church:*

Address of Church:*

*Please prepare to submit a copy of your Baptismal Certificate.

If you are baptized Catholic, are you requesting reception of the Sacrament of Confirmation?*

Are you requesting reception of the Sacrament of the Holy Eucharist?*

Sponsor

Do you have someone in mind to serve as your sponsor?*

If yes, please indicate his/her name and contact information:*

If none, would you like us to look for a Catholic Sponsor for you?*

Marriage Status:

*Please be assured that all information you give us will be kept confidential

If you are married, is this your first marriage?*

If yes, skip the following.

If remarried, please answer the following:

Which spouse was previously married?

Please state your reason(s) for joining the RCIA program:

*I attest to the truth of the information above.

Date: (ex. 00/00/0000)*