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Divine Mercy Parish Registration

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- Desired Household Mailing Title (i.e. Mr. and Mrs. John Doe) REQUIRED Please fill out this field. Please enter valid data.
- Please fill out information for each member listed in the mailing title in the Family Member Section Below.
- Address REQUIRED
  Line 1
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- Address
  Line 2
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- 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.
- Unlisted Phone Number REQUIRED Yes No Please fill out this field.
- Main Email Address REQUIRED Please fill out this field. Please enter an email address.
- Confirm Main Email Address REQUIRED Please fill out this field. Please enter an email address.
- Number of Family Members REQUIRED Please fill out this field.
  
  Family Member 1
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 2
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 3
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 4
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 5
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 6
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 7
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 8
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 9
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 10
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 11
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 12
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 13
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 14
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
  
  Family Member 15
  
  Family Member Type REQUIRED High School Age or Younger Adult Please fill out this field.
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Gender REQUIRED Female Male Please fill out this field.
  
  Race/Ethnicity Please enter valid data.
  
  Date of Birth
  
  Month REQUIRED Please fill out this field.
  
  Day REQUIRED Please fill out this field.
  
  Year REQUIRED Please fill out this field. Please enter valid data.
  
  Family Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field.
  
  Current Grade (if applicable) REQUIRED Please fill out this field.
  
  Sacraments Received
  
  Baptism REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  First Communion REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Confirmation REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Marriage REQUIRED Please fill out this field.
  
  Date (if applicable) Please enter a date.
  
  Comments
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