Our Lady of the Valley Catholic Church

New Family Registration Form

Please Print! - All information is condential, for church use only
Family Name __________________________ Todays Date ______/______/_______
Mailing Address (Please inform us of a Change of Address!)
______________________________________________________________Apt./Unit______
City __________________ , CA Zip Code____________
Phone (_______) -______-__________ E-mail________________________________________
Marital Status: Single Civil Church (Catholic) Divorced Cohabitant Widowed
1. Are You Involved in any Parish Ministries?
Yes, If so please state ministries involved __________________________________________________ No
2. Do you have children enrolled in a CCD Program
Yes, if so please state number of children enrolled ________ No
3. Are you interested in Volunteering in any of our programs offered at our parish?
Yes, if so please state programs of interest __________________________________________________ No
4. Is your family registered with other parishes within the Diocese of San Bernardino?
Yes, If so please state parishes you are currently registered at ________________________________________ No
5. Would you like to receive contribution envelopes?
Yes, If so, please state under which name _________________________________ No
Family Number
____________
Ofce Use Only
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth / / Religion(if not Catholic): Religion(if not Catholic):
Ethnicity
Primary Language
Occupation : Occupation : Occupation : Occupation :
Sacraments Received Sacraments Received Sacraments Received Date of Marriage (Catholic)
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation / /
Please, Use LEGAL NAME, when lling out the information below
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First Name: Last Name: Last Name: Gender Male Female
Date Of Birth / / Religion: (if not Catholic) Religion: (if not Catholic)
Ethnicity
Primary Language
Occupation : Occupation : Occupation : Occupation :
Sacraments Received Sacraments Received Sacraments Received Date of Marriage (Catholic)
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation / /
Continued on other side
OFFICE USE ONLY
Registered by ________________ Entered by ______________ Delivered Letter w/Temporary Envelopes Sent Letter w/yer
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
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First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
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First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation
First Name: Last Name: Last Name: Gender Male Female
Date Of Birth
Ethnicity
Primary Language
Relationship to Head of Household: Relationship to Head of Household: Occupation or Grade: Occupation or Grade:
Sacraments Received Sacraments Received Sacraments Received Sacraments Received
Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation Baptism (Roman Catholic) First Eucharist (Communion) Conrmation