RCIA Registration Form Information on this form is held in confidence, and is not shared without your permission. Name* First Middle Last Maiden (If Applicable) Date of Birth*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Age*Place of Birth* Father's Full Name* Mother's Full Name* (Please include maiden name)Contact InformationMailing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Cell Phone*Email Address* Religious HistoryPlease provide a copy of Sacramental certificates, regardless of religious affiliation by sending them to the parish office, if applicableWhat, if any, is your present religious affiliation?* Have you ever been baptized?* Yes No I am not sure. In what denomination were you baptized?* Place of Baptism If you were baptized Catholic, check those sacraments you have already received Penance (Confession) Eucharist (First Communion) Confirmation Current Marital Status(You must provide a copy of marriage certificate, civil divorce decree, and annulment, if applicable) Check the appropriate statement(s) below and provide any information requested beneath the statement(s)Marital Status* I have never been married I am engaged to be married I am married I am married, but separated from my spouse I am divorced and I have not remarried I am widowed and I have not remarried Do you have children?* Yes No Engagement InfoYour Fiancé's Full Name* Your Fiancé's Current Religious Affiliation (if none, put N/A)* For you:* This is my first marriage I have been married before. Please indicate how that marriage was resolved (divorced, annulled) For your Fiancé:* This is my fiancé's first marriage My fiancé have been married before. Please indicate how that marriage was resolved (divorced, annulled) Married InfoYour Spouse's Full Name* Your Spouse's Current Religious Affiliation (if none, put N/A)* For you:* This is my first marriage I have been married before. Please indicate how that marriage was resolved (divorced, annulled) For your Spouse:* This is my spouse's first marriage My spouse have been married before. Please indicate how that marriage was resolved (divorced, annulled) Date of Marriage*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Place of Marriage* Children InfoChildren*Add additional children information with the plus buttonNameAgeRelationship General QuestionsPlease describe your own religious education or church background*How have you come to be interested in the Roman Catholic Church?*Do you have any questions that you would like answered at this time?Is there one person in particular who is responsible for your interest in the Catholic Church? Will that person be acting as your sponsor, and walking this journey with you?*(A Sponsor must be 16 years of age or older, a Confirmed Catholic, attending Mass, and actively participating in the sacramental life of the Catholic Church)CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.