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  • 

    PARISH MEMBERSHIP FORM

  • Form Date: REQUIRED Please fill out this field. Please enter a date.
  • Please complete this section with your information.
    • Select a Parish to join: REQUIRED

      Please select a Parish

      (Select One) Nativity of the Blessed Virgin Mary St Mary of the Lake Please fill out this field.
    • Please make a selection: REQUIRED (Select One) New Member Former member of Nativity of the Blessed Virgin Mary Former member of St Mary of the Lake Please fill out this field.
    • Title:

      Optional

      None Mr. 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.
    • Street Address REQUIRED Please fill out this field. Please enter valid data.
    • City REQUIRED Please fill out this field. Please enter valid data.

      State REQUIRED AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY Please fill out this field.

      Zip REQUIRED Please fill out this field. Please enter a zip code.
    • Phone Number REQUIRED

      Please enter only a Home or Personal Cell number. Thank you

      Please fill out this field. Please enter a phone number.
    • Personal Email Address

      Please enter your personal email address

      Please enter an email address.
    • Mailing Address (If different than above) - Skip (if the same) Please enter valid data.
    • City Please enter valid data.

      State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

      Zip Please enter a zip code.
    • Sex REQUIRED (Select One) M F Please fill out this field.
    • Birth Date REQUIRED

      Simply type in the box... MM/DD/YYYY

      Please fill out this field. Please enter a date.
    • Marital Status: REQUIRED (Select One) Single Divorced Separated Widowed Married - Roman Catholic Church Marriage Married - Civil Marriage Please fill out this field.
    • Religion REQUIRED

      If Other, plese select other and write in below

      (Select One) Roman Catholic Methodist Baptist Episcopal Other Please fill out this field.
    • If Other Please enter valid data.
    • Current Church Attendance REQUIRED (Select One) Regularly Occasionally Seldom Never Summer Only Please fill out this field.
    • Handicap None No Yes, Physically Prefer not to disclose
    • Occupation REQUIRED Please fill out this field. Please enter valid data.
    • Would you be interested in joining a Parish Ministry? REQUIRED (Select One) Yes, Please contact me with more information No, Not at this time Please fill out this field.
  • Please complete this section with information about your received sacraments.
    • My Baptism REQUIRED (Select One) Yes No Please fill out this field.
    • My Baptism Year Please enter valid data.
    • My Baptism Parish Please enter valid data.
    • City Please enter valid data.

      State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

      Zip Please enter a zip code.
    • My First Communion REQUIRED (Select One) No Yes Please fill out this field.
    • My First Communion Year Please enter valid data.
    • My First Communion Parish Please enter valid data.
    • City Please enter valid data.

      State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

      Zip Please enter a zip code.
    • My Confirmation None No Yes
    • My Confirmation Year Please enter valid data.
    • My Confirmation Parish Please enter valid data.
    • City Please enter valid data.

      State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

      Zip Please enter a zip code.
    • My Matrimony REQUIRED (Select One) No Yes Please fill out this field.
    • My Matrimony Year Please enter valid data.
    • My Matrimony Parish Please enter valid data.
    • City Please enter valid data.

      State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

      Zip Please enter a zip code.
  • This section is for information about a child that may be joining with you.  Please complete it with their information.
  • Will children being joing the parish with you? REQUIRED

    If yes, please remember to fill out their individual information further in the form. Thank you

    (Select One) No, I am skipping over the next section Yes, I will complete their information below Please fill out this field.
  • • Please enter the number of children joining with you REQUIRED
      If 0, please skip over this section. Thank you
      Please fill out this field.
    • Child 1
      • First Name Please enter valid data.

        Last Name Please enter valid data.
      • Sex None M F
      • Child's Birth Date

        MM/DD/YYYY

        Please enter a date.
      • Child's Baptism None Yes No
      • Child's Baptism Date Please enter valid data.
      • Child's Baptism Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's First Communion None Yes No
      • Child's First Communion Date Please enter valid data.
      • Child's First Communion Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's Confirmation None Yes No
      • Child's Confirmation Date Please enter valid data.
      • Child's Confirmation Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
    • Child 2
      • First Name Please enter valid data.

        Last Name Please enter valid data.
      • Sex None M F
      • Child's Birth Date

        MM/DD/YYYY

        Please enter a date.
      • Child's Baptism None Yes No
      • Child's Baptism Date Please enter valid data.
      • Child's Baptism Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's First Communion None Yes No
      • Child's First Communion Date Please enter valid data.
      • Child's First Communion Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's Confirmation None Yes No
      • Child's Confirmation Date Please enter valid data.
      • Child's Confirmation Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
    • Child 3
      • First Name Please enter valid data.

        Last Name Please enter valid data.
      • Sex None M F
      • Child's Birth Date

        MM/DD/YYYY

        Please enter a date.
      • Child's Baptism None Yes No
      • Child's Baptism Date Please enter valid data.
      • Child's Baptism Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's First Communion None Yes No
      • Child's First Communion Date Please enter valid data.
      • Child's First Communion Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's Confirmation None Yes No
      • Child's Confirmation Date Please enter valid data.
      • Child's Confirmation Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
    • Child 4
      • First Name Please enter valid data.

        Last Name Please enter valid data.
      • Sex None M F
      • Child's Birth Date

        MM/DD/YYYY

        Please enter a date.
      • Child's Baptism None Yes No
      • Child's Baptism Date Please enter valid data.
      • Child's Baptism Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's First Communion None Yes No
      • Child's First Communion Date Please enter valid data.
      • Child's First Communion Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
      • Child's Confirmation None Yes No
      • Child's Confirmation Date Please enter valid data.
      • Child's Confirmation Parish Please enter valid data.
      • City Please enter valid data.

        State None AK AL AR AS AZ CA CO CT DC DE FL GA GU HI IA ID IL IN KS KY LA MA MD ME MH MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA PR PW RI SC SD TN TX UT VA VI VT WA WI WV WY

        Zip Please enter a zip code.
  • I have completed this form accurate information.  I realize that some information may need to be confirmed prior to my becoming a member of the Catholic Community of Nativity of the Blessed Virgin Mary and St Mary of the Lake.  I understand that I may be contacted  by members of the Parish office to complete my membership.

    By checking this box, I agree with the statement listed above. Please select this field.
  • Please re-enter your personal email address REQUIRED Please fill out this field. Please enter an email address.

  Submit

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