New Member Registration

St. Luke the Evangelist Catholic Church
Online Registration

Name *
Name
Address *
Address
Gender
Date of Birth
Date of Birth
Home Phone *
Home Phone
Phone Number
Work Phone
Work Phone
Phone Number
Cell Phone
Cell Phone
Phone Number
May we share your information with parish groups?
Check all that apply
Catholic?
First Reconciliation?
First Eucharist?
Confirmation?
Valid Catholic Marriage
Do we have permission to photograph or record (video/audio) this member for the use of media or website?
Tithing
Individual Member #2 (please skip if you are a single parent)
Member #2 Name
Member #2 Name
Parish Status
Select one
Date of Birth
Date of Birth
Work Phone
Work Phone
Phone Number
Cell Phone
Cell Phone
Phone Number
Catholic?
First Reconciliation?
First Eucharist?
Confirmation?
Do we have permission to photograph or record (video/audio) this member for the use of media or website?
Individual Member #3
Member #3 Name
Member #3 Name
Date of Birth
Date of Birth
Catholic?
First Reconciliation?
First Eucharist?
Confirmation?
Do we have permission to photograph or record (video/audio) this member for the use of media or website?
Individual Member #4
Member #4 Name
Member #4 Name
Date of Birth
Date of Birth
Catholic?
First Reconciliation?
First Eucharist?
Confirmation?
Do we have permission to photograph or record (video/audio) this member for the use of media or website?
Please provide similar information about any additional family member(s) who wish to join St. Luke's
Do we have permission to photograph or record (video/audio) these members for the use of media or website?