Parish Registration

Berlin, NJ

St. Simon Stock Parish Family Registration

Use the form below to join our parish. Please be sure to fill in as much information as possible, particularly the appropriate "Yes" checkboxes.

Basic Information

Last Name

First Name(s)

Formal Mailing Name (ie Mr. & Mrs. John Doe)

Informal Name

Address

Address 2

City

State

Zip Code

Home Phone

Emergency Phone

Family E-mail

Individual Member Information

	Member 1	Member 2
Parish Status
Role (Head of House, Husband, Wife, etc.)
First Name/Nickname	/	/
Middle Name/Initial
Last Name/Maiden Name	/	/
Gender
Date of Birth (mm/dd/yyyy)
Place of Birth
E-mail
Work Phone/Cell Phone	/	/
First Language
Ethnicity
Occupation
Employer
Sacramental Info
Baptized	Yes Catholic? Yes When, if known? (mm/dd/yyyy)	Yes Catholic? Yes What Faith? When, if known? (mm/dd/yyyy)
Reconciliation	Yes When, if known? (mm/dd/yyyy)	Yes When, if known? (mm/dd/yyyy)
First Eucharist	Yes When, if known? (mm/dd/yyyy)	Yes When, if known? (mm/dd/yyyy)
Confirmation	Yes When, if known? (mm/dd/yyyy)	Yes When, if known? (mm/dd/yyyy)
Marital Status	Valid Catholic Marriage? Yes Marriage Date (mm/dd/yyyy)

Marriage Church & Priest, if applicable

Dependent Children Information

Abuse Checks:

//]]>