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Divine Mercy Parish
Parish CenteR
164 Washington Place
412-471-0257
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Family Member 11
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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
(Select One)
January
February
March
April
May
June
July
August
September
October
November
December
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Day
REQUIRED
(Select One)
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
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
(Select One)
Roman Catholic
Baptist
Christian
Episcopalian
Jewish
Lutheran
Methodist
Non-denominational
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
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Sacraments Received
Baptism
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
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
(Select One)
January
February
March
April
May
June
July
August
September
October
November
December
Please fill out this field.
Day
REQUIRED
(Select One)
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
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
(Select One)
Roman Catholic
Baptist
Christian
Episcopalian
Jewish
Lutheran
Methodist
Non-denominational
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.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
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
(Select One)
January
February
March
April
May
June
July
August
September
October
November
December
Please fill out this field.
Day
REQUIRED
(Select One)
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
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
(Select One)
Roman Catholic
Baptist
Christian
Episcopalian
Jewish
Lutheran
Methodist
Non-denominational
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.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
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
(Select One)
January
February
March
April
May
June
July
August
September
October
November
December
Please fill out this field.
Day
REQUIRED
(Select One)
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
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
(Select One)
Roman Catholic
Baptist
Christian
Episcopalian
Jewish
Lutheran
Methodist
Non-denominational
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.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
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
(Select One)
January
February
March
April
May
June
July
August
September
October
November
December
Please fill out this field.
Day
REQUIRED
(Select One)
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
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
(Select One)
Roman Catholic
Baptist
Christian
Episcopalian
Jewish
Lutheran
Methodist
Non-denominational
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.
Date (if applicable)
Please enter a date.
First Communion
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Confirmation
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Marriage
REQUIRED
(Select One)
Yes
No
Please fill out this field.
Date (if applicable)
Please enter a date.
Comments
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