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Divine Mercy Parish
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164 Washington Place
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21
22
23
24
25
26
27
28
29
30
31
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Year
REQUIRED
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Please enter valid data.
Family Relationship
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Religion
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None
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Current Grade (if applicable)
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(Select One)
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
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Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
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Date (if applicable)
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First Communion
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(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
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Parish Address
REQUIRED
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Date (if applicable)
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Confirmation
REQUIRED
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Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
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Parish Address
REQUIRED
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Date (if applicable)
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Marriage
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
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Comments
Family Member 9
Family Member Type
REQUIRED
High School Age or Younger
Adult
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First Name
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Middle Name
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Last Name
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Date of Birth
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
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Please enter valid data.
Family Relationship
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Religion
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None
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Current Grade (if applicable)
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(Select One)
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
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Marriage
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
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Parish Address
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Date (if applicable)
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Comments
Family Member 10
Family Member Type
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High School Age or Younger
Adult
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First Name
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Middle Name
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Last Name
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Race/Ethnicity
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Date of Birth
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Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
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Please enter valid data.
Family Relationship
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Religion
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None
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Current Grade (if applicable)
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Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
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Please enter valid data.
Parish Address
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Date (if applicable)
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Marriage
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(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
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Please enter valid data.
Parish Address
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Date (if applicable)
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Comments
Family Member 11
Family Member Type
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High School Age or Younger
Adult
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First Name
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Middle Name
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Last Name
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Date of Birth
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Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
REQUIRED
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Please enter valid data.
Family Relationship
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Religion
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None
Please fill out this field.
Current Grade (if applicable)
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Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
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Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
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Comments
Family Member 12
Family Member Type
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High School Age or Younger
Adult
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First Name
REQUIRED
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Please enter valid data.
Middle Name
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Last Name
REQUIRED
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Gender
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Race/Ethnicity
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Date of Birth
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Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
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Family Relationship
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Religion
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None
Please fill out this field.
Current Grade (if applicable)
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Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
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Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
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Comments
Family Member 13
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REQUIRED
High School Age or Younger
Adult
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First Name
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Middle Name
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Race/Ethnicity
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Date of Birth
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Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
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Family Relationship
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Religion
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Roman Catholic
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Other
None
Please fill out this field.
Current Grade (if applicable)
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Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
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Parish
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Parish where the sacrament was received
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Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
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Marriage
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Yes
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Parish
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Parish where the sacrament was received
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Parish Address
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Date (if applicable)
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Comments
Family Member 14
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Adult
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First Name
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Middle Name
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Last Name
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Date of Birth
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September
October
November
December
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Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
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Religion
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None
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Current Grade (if applicable)
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Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
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Marriage
REQUIRED
(Select One)
Yes
No
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Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
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Date (if applicable)
Please enter a date.
Comments
Family Member 15
Family Member Type
REQUIRED
High School Age or Younger
Adult
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First Name
REQUIRED
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Middle Name
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Last Name
REQUIRED
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Gender
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Date of Birth
Month
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January
February
March
April
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June
July
August
September
October
November
December
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Day
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01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
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Year
REQUIRED
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Please enter valid data.
Family Relationship
REQUIRED
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Please enter valid data.
Religion
REQUIRED
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Roman Catholic
Baptist
Christian
Episcopalian
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Lutheran
Methodist
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Presbyterian
Other
None
Please fill out this field.
Current Grade (if applicable)
REQUIRED
(Select One)
Pre-K
K
1
2
3
4
5
6
7
8
9
10
11
12
N/A
Please fill out this field.
Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
Please fill out this field.
Please enter valid data.
Parish Address
REQUIRED
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Parish
REQUIRED
Parish where the sacrament was received
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Parish Address
REQUIRED
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Date (if applicable)
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