Parishioner Registration

ST. MARY'S CATHOLIC CHURCH

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SACRAMENTS
FORMATION
HEALING
STEWARDSHIP
DONATE
NEWS & EVENTS

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Register to be a Parishioner

* Indicates required field

Family Last Name *

Home Phone *

Please include area code.

Address *

Email *

City *

Zip *

Church Support *

Our Automatic Withdrawal Form can be downloaded and returned to the church office. Please do not set up automatic withdrawal through PayPal.

ADULT 1

FIRST NAME *

MIDDLE NAME *

LAST NAME *

Maiden Name (If applicable) *

Gender *

Cell Number *

Please include area code.

Date of Birth *

MARK ALL SACRAMENTS COMPLETED IN THE CATHOLIC CHURCH *

Baptism Holy Communion Confirmation Matrimony None

ADULT 2

FIRST NAME *

MIDDLE NAME *

LAST NAME *

Maiden Name (If applicable) *

Gender *

Cell Number *

Please include area code.

Date of Birth *

MARK ALL SACRAMENTS COMPLETED IN THE CATHOLIC CHURCH *

Baptism Holy Communion Confirmation Matrimony None

Please fill out the following information if you have children living at home.

CHILD 1

FIRST NAME *

MIDDLE NAME *

LAST NAME *

School Attending *

GRADE *

Gender *

Date of Birth *

SACRAMENTS COMPLETED *

Baptism First Communion Confirmation

CHILD 2

FIRST NAME *

MIDDLE NAME *

LAST NAME *

School Attending *

Grade *

Gender *

Date of Birth *

Sacraments Completed *

Baptism First Communion Confirmation

CHILD 3

FIRST NAME *

MIDDLE NAME *

LAST NAME *

School Attending *

Grade *

Gender *

Date of Birth *

Sacraments Completed *

Baptism First Communion Confirmation

CHILD 4

FIRST NAME *

MIDDLE NAME *

LAST NAME *

School Attending *

Grade *

Gender *

Date of Birth *

Sacraments Completed *

Baptism Holy Communion Confirmation

Additional Family Members *

Submit

ST. MARY'S CATHOLIC CHURCH
119 E. HOWARD ST., PONTIAC, IL 61764
PHONE (815) 844-7683 FAX (815) 842-4345

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