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Bulletin  - Palmer Catholic Academy
 
   Registration
 
   

If you wish to register as a member of our parish, please take a few moments to fill out the
registration form below.  Click on the Submit button to send your information to our office.

New Parishioner Registration Form

Family Last Name:         

Street Address Line #1:   Street Address Line #2:

City:     State:       Zip:

Home Phone:   Cell Phone: Email:


Will you use Offertory envelopes?: Yes No
  Registrant (1) Spouse (2) Child (3) Child (4) Child (5) Child (6)
First Name
Middle Name
Title
Last Name         (if different from Family name listed above)
Occupation        
Business Phone        
Birth Date
Baptized Catholic Yes No Yes No Yes No Yes No Yes No Yes No
1st Communion Yes No Yes No Yes No Yes No Yes No Yes No
1st Penance Yes No Yes No Yes No Yes No Yes No Yes No
Confirmed Yes No Yes No Yes No Yes No Yes No Yes No
Married Yes No Yes No
Married by a Catholic Priest Yes No Yes No
Marriage Date
Single /Widowed / Divorced S W D S W D

Comments:

 

 
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