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Registration

You will receive an email confirming that we have received your registration. Once you are registered, we will mail you a welcome letter and temporary envelopes.

FAMILY INFORMATION

Items with an * require an answer.
1.
*

Family Last Name:
2.
*

Street Address:
3.
*

City & Zip:
4.
*

Phone:
5.

Mailing Address (if different) or P.O. box:
6.
*

Email:

FAMILY STATUS
7.
*

Family Status:

 (1 required)
Single   Married by Catholic priest
Widow/widower   Separated
Divorced   Other marriage (Lutheran, civil, etc.)
8.

If you checked Other Marriage, please explain:
9.

Wedding Date:
10.

Church:
11.

City & State::

HEAD OF HOUSEHOLD
12.
*

Full Name:
13.

Maiden Name (if applicable):
14.

Nickname:
15.
*

Gender:
Male   Female
16.
*

Birth Date:
17.
*

City & State of Birth:
18.
*

Religion:
19.
*

Occupation:
20.

Employer:
21.

Work Phone:
22.

Language:
23.

Handicap:
24.
*

Baptism:
Yes   No
25.

Date, Church, City & State:
26.
*

1st Eucharist:
Yes   No
27.

Date, Church, City & State:
28.
*

Confirmation:
Yes   No
29.

Date, Church, City & State:

SPOUSE
30.

Full Name:
31.

Maiden Name (if applicable):
32.

Nickname:
33.

Gender:
Male   Female
34.

Birth Date:
35.

City & State of Birth:
36.

Religion:
37.

Occupation:
38.

Employer:
39.

Work Phone:
40.

Language:
41.

Handicap:
42.

Baptism:
Yes   No
43.

Date, Church, City & State:
44.

First Eucharist:
Yes   No
45.

Date, Church, City & State:
46.

Confirmation:
Yes   No
47.

Date, Church, City & State:

CHILD
48.

Full Name:
49.

Nickname:
50.

Gender:
Male   Female
51.

Birth Date:
52.

City & State of Birth:
53.

Religion:
54.

School:
55.

Grade:
56.

Handicap:
57.

Language:
58.

Baptism:
Yes   No
59.

Church, Date, City & State:
60.

1st Eucharist:
Yes   No
61.

Church, Date, City & State:
62.

Confirmation:
Yes   No
63.

Church, Date, City & State:

CHILD
64.

Full Name:
65.

Nickname:
66.

Gender:
Male   Female
67.

Birth Date:
68.

City & State of Birth:
69.

Religion:
70.

School:
71.

Grade:
72.

Handicap:
73.

Language:
74.

Baptism:
Yes   No
75.

Church, Date, City & State:
76.

1st Eucharist:
Yes   No
77.

Church, Date, City & State:
78.

Confirmation:
Yes   No
79.

Church, Date, City & State:

CHILD
80.

Full Name:
81.

Nickname:
82.

Gender:
Male   Female
83.

Birth Date:
84.

City & State of Birth:
85.

Religion:
86.

School:
87.

Grade:
88.

Handicap:
89.

Language:
90.

Baptism:
Yes   No
91.

Church, Date, City & State:
92.

1st Eucharist:
Yes   No
93.

Church, Date, City & State:
94.

Confirmation:
Yes   No
95.

Church, Date, City & State:

COMMENTS
96.

Questions/comments/concerns:

* Enter Your Email Address:

Type in the text that you see above:

  

St. Rita Catholic Church          St Rita Catholic School
6254 Valley Knoll Drive                6284 Valley Knoll Drive
Rockford, IL 61109                      Rockford,  IL  61109 
Phone: 815-398-0853                  Phone: 815-398-3466
Fax:  815-397-7499                     Fax 815-398-6104

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