FAMILY NAME ______________________________________________________________________
ST. DENNIS PARISH CENSUS INFORMATION
ADDRESS: __________________________________________________________________________________________________
CITY/STATE/ZIP: __________________________________________________________________________________________
HOME PHONE NUMBER: ________________________________________________________________________________
FAMILY E-MAIL ADDRESS: ______________________________________________________________________________
TODAYS DATE: _____________________
Envelope No. _________________________
I/We would like information on:
_____ RCIA
_____ Baptism
_____ School
_____ GIFTs Program
_____ Blessing of Marriage
_____ Blessing of Home
FAMILY STATUS please circle one: Single, Married, Divorced, Remarried, Widow/Widower, Engaged
HUSBANDS FIRST NAME: ________________________________________
PREFERRED NICK NAME: ______________________________________________________
CELL PHONE: ______________________________________________________
E-MAIL ADDRESS: _______________________________________________________________
BIRTH DATE: ______________________________________________________
OCCUPATION: __________________________________________________________________
WHERE EMPLOYED: ______________________________________________
BUSINESS PHONE: ______________________________________________________________
DO YOU SPEAK A 2ND LANGUAGE? ___________________________
IF YES, WHICH ONE? ___________________________________________________________
RELIGION: __________________________________________________________
SACRAMENTS: Please indicate YES or NO
BAPTISM __________
1st COMMUNION __________
CONFIRMATION __________
MARRIED BY PRIEST/DEACON__________
CHURCH OF MARRIAGE: ________________________________________
DATE OF MARRIAGE: __________________________________________________________
WIFEs FIRST NAME: _____________________________________________
WIFEs MAIDEN NAME: ________________________________________________________
CELL PHONE: ______________________________________________________
E-MAIL ADDRESS: _______________________________________________________________
BIRTH DATE: ______________________________________________________
OCCUPATION: __________________________________________________________________
WHERE EMPLOYED: ______________________________________________
BUSINESS PHONE: ______________________________________________________________
DO YOU SPEAK A 2ND LANGUAGE? ___________________________
IF YES, WHICH ONE? ___________________________________________________________
RELIGION: __________________________________________________________
SACRAMENTS: Please indicate YES or NO
BAPTISM __________
(over)
1st COMMUNION __________
CONFIRMATION __________
MARRIED BY PRIEST/DEACON__________
CHILDREN LIVING AT SAME ADDRESS
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: _____________ Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
OTHER ADULTS LIVING AT SAME ADDRESS (PARENTS/IN-LAWS/SIBLINGS)
NAME: ___________________________________________________ BIRTH DATE: _______________
HOW RELATED?____________________________________________ Special Needs (if any) _______________
Please use another sheet of paper if needed:
How can we help you? Do you have any particular needs at this time, ie., Home-bound visits, nursing home visits, etc.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Would you share your talents/time with us? Please check the Ministry description/signup sheets. _______________________
_____________________________________________________________________________________________________