Online Parish Registration

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Street 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.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

Date of Birth REQUIRED Please fill out this field. Please enter a date.

Ethnicity REQUIRED Please fill out this field. Please enter valid data.

Religion REQUIRED Please fill out this field. Please enter valid data.

Occupation Please enter valid data.

Marital Status REQUIRED Divorced Married Remarried Single Widowed Please fill out this field.

Place of Marriage (If applicable) Please enter valid data.

Address of Place of Marriage

Date of Marriage Please enter valid data.

Name of Spouse (If married...if not applicable please put NA) REQUIRED Please fill out this field. Please enter valid data.

Date of Birth of Spouse (If applicable) Please enter a date.

Ethnicity of Spouse (If applicable) Please enter valid data.

Religion (If applicable) Please enter valid data.

Occupation (If applicable) Please enter valid data.

Names and Birthdate of Children (If not applicable, please type NA) REQUIRED Please fill out this field.

Sacramental Information of those living in the household (Baptism, Confirmation, and First Communion)

We would like more information on... Becoming a Catholic (R.C.I.A) Immaculate Conception Religious Education Liturgical Ministries (Altar Serving, Extraordinary Ministers, Lector, Usher, etc.) Music Ministry Saint Teresa of Calcutta Catholic School Other Additional Volunteer Opportunities in the Parish

I would like to volunteer the following skills

I would like to volunteer for the following ministries

Just moved into the area...would you like your house blessed? Yes No

Immaculate Conception Church, New Oxford Pa

Online Parish Registration

WELCOME TO IMMACULATE CONCEPTION CHURCH!!!

ONLINE PARISH REGISTRATION FORM...