Filing Name _________________
ST. BERNADETTE PARISH
EnvNo/ID
FAMILY REGISTRATION FORM
Date Registered _____________
(FAMILY COVER SHEET)
FAMILY
NAME
_________________
Family Last Name:
First Name and Middle Initial:
Title: Mr. Mrs. Ms. Miss Mr. & Mrs.
Other ________________________
Suffix: Jr. Sr. III
Other: _______________
FAMILY ADDRESS
Street Address:
City:
State:
Zip:
Mailing Address if different:
Other/Seasonal Address if you use one:
Please indicate when to use other address:
FAMIY
CONTACT INFO
Preferred Family Phone Numbers:
Land Line (____) ____ - ________
(List other numbers on member pages)
Unlisted?
Y N
Cell (____) ____ - ________ belongs to which member ______________
Preferred Family Email Address: (List other email info on member pages)
REMARKS:
St. Bernadette Parish
Parish
5930 South Abbott Rd. Orchard Park, NY 14127-4597
716-649-3090 www.StBernadetteOPNY.org
Filing Name _____________
EnvNo/ID
_____________
ADULT MEMBERS FOR FAMILY REGISTRATION
PERSONAL INFORMATI0N
HEAD OF HOUSEHOLD
Name - Last, First, Middle, Maiden
Name - Last, First, Middle, Maiden
Title: Mr. Mrs. Ms. Miss Dr. Other: _____
Title: Mr. Mrs. Ms. Miss Dr. Other: _____
Suffix: Jr. Sr. III Other: ________
Suffix: Jr. Sr. III Other: ________
Grade/Degree
Grade/Degree
Gender:
M
F
Birth date
/
Gender:
M
Ethnicity
Religion
Religion
Occupation
Employer
Occupation
Employer
Special Needs
Special Needs
Unlisted?
F
Birth date
Personal Phone Numbers
/
/
Unlisted?
Cell
(
)
Y N
Cell
(
)
Y N
Work
(
)
Y N
Work
(
)
Y N
Other (
)
Y N
Other (
)
Y N
Personal Email Addresses
Preferred?
Personal Email Addresses
Preferred?
Work
Work
Other
Other
Date:
Church:
City/State:
BAPTISM
Personal
Date:
Church:
City/State:
Date:
Church:
City/State:
CONFIRM ED
BAPTISM
Personal
CONFIRM ED
PERSONAL CONTACTS
/
Ethnicity
Personal Phone Numbers
SACRAMENTAL INFO
SPOUSE
Date:
Church:
City/State:
MARRIAGE: Date:
REMARKS OR DETAILS
Church:
City/State: