Parish Registration

- Welcome

The maximum number of form submissions has been reached. This form is currently not available.
- Please enter all fields below and click the submit button. This will register you and any additional family members entered will be registered as parishioner(s). You may be contacted if additional information is required.
- New Registrant
- Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Title REQUIRED Please fill out this field.
  
  Preferred Name Please enter valid data.
  
  Religion REQUIRED
  Enter your religion
  Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED
  Enter the month, day and year of your birth
  Please fill out this field. Please enter a date.
  
  Sex REQUIRED Male Female Please fill out this field.
  
  Marital Status REQUIRED Please fill out this field.
  
  Date Married
  Enter the month, day and year of your marriage
  Please enter a date.
  
  Married in Catholic Church (or with Catholic Church approval) Yes No
  
  Location of Marriage
  Enter the name of the place where you were married, city and state
  Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Additional Email
  Enter a secondary email you wish to be contacted through, ex.: work or school email
  Please enter an email address.
  
  Home Phone Number REQUIRED Maximum 20 characters
  Enter your home phone number
  Please fill out this field. Please enter a phone number.
  
  Enter type of phone REQUIRED
  Please enter if this phone is a land line or a mobile phone, this will help us determine best methods of communications.
  Please fill out this field.
  
  Mobile Phone Number Maximum 20 characters
  Enter your mobile phone number
  Please enter a phone number.
  
  By entering a mobile phone number above, I agree to be contacted via text messaging.
  I Agree Please select this field.
  
  Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Previous Parish Maximum 120 characters
  Enter the name of your previous parish with city and state
  Please enter valid data.
  
  Sacraments Received REQUIRED Baptism First Communion Confirmation Please fill out this field.
  
  Year and Parish of Baptism Maximum 120 characters
  Please enter the year and church name, with city and state, of your Baptism
  Please enter valid data.
  
  Year and Parish of First Communion Maximum 120 characters
  Please enter the year and parish, city and state, of your First Communion
  Please enter valid data.
  
  Year and Parish of Confirmation Maximum 120 characters
  Please enter the year and parish, with city and state, of your Confirmation
  Please enter valid data.
  
  Occupation Please enter valid data.
  
  Place of Employment Please enter valid data.
- Family Members
- Enter Spouse's information
  
  Spouse
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Title
  
  Date of Birth
  Enter the month, day and year of your birth
  Please enter a date.
  
  Sacraments Received Baptism First Communion Confirmation
  
  Year and Parish of Baptism Maximum 120 characters
  Please enter the year and church name, with city and state, of your Baptism
  Please enter valid data.
  
  Year and Parish of First Communion Maximum 120 characters
  Please enter the year and parish, city and state, of your First Communion
  Please enter valid data.
  
  Year and Parish of Confirmation Maximum 120 characters
  Please enter the year and parish, with city and state, of your Confirmation
  Please enter valid data.
  
  Occupation Maximum 60 characters Please enter valid data.
  
  Place of Employment Maximum 60 characters Please enter valid data.
  
  Email Please enter an email address.
  
  Phone Number Maximum 20 characters Please enter a phone number.
  
  Enter type of phone
  Please enter if this phone is a land line or a mobile phone, this will help us determine best methods of communications.
  
  Mobile Phone Number Maximum 20 characters Please enter a phone number.
  
  By entering a mobile phone number above, I agree to be contacted via text.
  I Agree Please select this field.
- Enter Number of Children you wish to Register REQUIRED Please fill out this field.
  
  Child 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 5
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 6
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 7
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 8
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 9
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 10
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 11
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
  
  Child 12
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Birth Date REQUIRED
  Enter the birth date of your child
  Please fill out this field. Please enter a date.
  
  School attending and current grade Maximum 50 characters
  Enter the name of the school your child attends and their current grade
  Please enter valid data.
  
  Enter the year and parish of sacraments for your child.
  
  Baptism Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Baptism
  Please enter valid data.
  
  First Communion Maximum 100 characters
  Enter the year, name of church, city and state, of your child's First Communion
  Please enter valid data.
  
  Confirmation Maximum 100 characters
  Enter the year, name of church, city and state, of your child's Confirmation
  Please enter valid data.
- Additional persons in residence you wish to register
- First Name Please enter valid data.
  
  Last Name Please enter valid data.
- Birth Date
  Enter Birth date
  Please enter a date.
- Email Please enter an email address.
- Mobile Phone Number Maximum 20 characters
  Please enter a mobile phone number
  Please enter a phone number.
- How is this person related to you?
  Enter the relationship of other persons living at the same address
  Please enter valid data.
- Year and Parish of Baptism Maximum 120 characters
  Please enter the year and church name, with city and state, of your Baptism
  Please enter valid data.
- Year and Parish of First Communion Maximum 120 characters
  Please enter the year and church name, with city and state, of your First Communion
  Please enter valid data.
- Year and Parish of Confirmation Maximum 120 characters
  Please enter the year and church name, with city and state, of your Confirmation
  Please enter valid data.
- Offertory Envelopes
- Envelopes will be sent to the address provided, unless you select an optional method below.
  Please select an optional method of offertory.
  I would like to make my offering through ACH Bank Draft (complete form below) I will make my offering using the Online Giving option
- ACH Authorization (Optional)
  
  Sample Check for location of routing and account numbers
  
  Financial Institution Maximum 40 characters
  Enter the name of your financial institution
  Please enter valid data.
  
  Routing Number Maximum 10 characters
  Enter your bank's routing number
  Please enter valid data.
  
  Account Number Maximum 15 characters
  Enter your bank account number
  Please enter valid data.
  
  Beginning Date
  Enter the date you wish debits to begin, this may take up to one month depending on your financial institution
  Please enter a date.
  
  I certify I am the account holder on the checking account above and as such do AUTHORIZE St. Francis of Assisi Catholic Church to initiate monthly electronic debit transactions to my checking account for payment of CHARITABLE DONATIONS. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. This authority will remain in effect until I have cancelled it in writing.
  I Agree Please select this field.
- Submit registration
  By submitting this form I agree that I am registering (with my family) as parishioner(s) of St. Francis of Assisi Catholic Church in Madison, Mississippi. An email verification will be sent to the email address provided and my contact information will only be used to register at this parish. If I selected ACH option for my offering method, I understand I will be contacted for additional information.
  I Agree Please select this field.
Submit

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