Registration Form

Family Name REQUIRED Please fill out this field. Please enter valid data.

Address REQUIRED Please fill out this field. Please enter valid data.

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.

Home Phone No. REQUIRED Please fill out this field. Please enter a phone number.

Cell Phone No. REQUIRED Please fill out this field. Please enter a phone number.

Email Address Please enter valid data.

Last Parish Membership Please enter valid data.

Marital Status: REQUIRED Single Married Divorced Widowed Separated Please fill out this field.

Member 1:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Birth Date REQUIRED Please fill out this field. Please enter a date.
Gender REQUIRED Please fill out this field.
Religion REQUIRED Please fill out this field. Please enter valid data.
Occupation Please enter valid data.

Member 2:

Additional Members:

If you have additional immediate family members that live in your home and attend St. Elizabeth Seton Parish, please give their information here:

Emergency Contact

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Relationship REQUIRED Please fill out this field. Please enter valid data.
Phone No. REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.

Do you want offertory envelopes? REQUIRED Yes No Please fill out this field.

Do you want to sign up for online giving? REQUIRED Yes No Please fill out this field.

Are you a part year resident? REQUIRED Yes No Please fill out this field.

If yes, what is your alternate address? Please enter valid data.

Would you like to receive text messages with important updates from us? REQUIRED Yes No Please fill out this field.