St. Nicholas New Parishioner Form

New Parishioner Form

Personal Information
To become a registered member of St. Nicholas Catholic Church of Belle River, complete the form below, then scroll to the bottom of the page and click "submit."
Family Last Name*
Last
Address*
Street Address City State / Province / Region ZIP / Postal Code
Email*
Information
Name*
First Middle Last
Maiden Name
Phone*
Indicate phone type:*
- Cell
- Home Landline
Religion*
Gender*
- Male
- Female
Date of Birth*
MM slash DD slash YYYY
Occupation*
Employer
Baptized?*
- Yes
- No
First Communion?*
- Yes
- No
Confirmation?*
- Yes
- No
Marital Status*
Date of Marriage*
MM slash DD slash YYYY
Spouse's Name*
First Middle Last
Maiden Name
Spouse's Phone*
Indicate phone type:*
- Cell
- Home Landline
Spouse's Religion*
Spouse's Gender*
- Male
- Female
Spouse's Date of Birth*
MM slash DD slash YYYY
Spouse's Occupation*
Spouse's Employer
Spouse Baptized?*
- Yes
- No
Spouse First Communion?*
- Yes
- No
Spouse Confirmation?*
- Yes
- No
Dependents
Do you have dependents living at home or in college?*
- No
- Yes
Dependent's Details
Please provide the following details for your first dependent. Click on the "+" icon below to add fields for each additional dependent. Click on the "-" icon if you need to remove an added section of fields.
Dependent's Details
First Name Last Name Date of Birth Gender Grade Baptized? (Y/N) First Communion? (Y/N) Confirmation? (Y/N)
Additional Information
Would you like to receive the Central Minnesota Catholic Magazine?*
- Yes
- No
CAPTCHA

First Name	Last Name	Date of Birth	Gender	Grade	Baptized? (Y/N)	First Communion? (Y/N)	Confirmation? (Y/N)