St. Roch Parish Registration

Thanks for taking a moment to register your household's information with our parish's office. Please fill out the form as completely as possible and then click submit.

Primary Information
Is this information:
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First Name
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Last Name
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Gender
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Household role
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Name of Spouse
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Address
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Primary Phone --
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Secondary Phone (work) --
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Spouse Phone --
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Spouse Alternate Phone --
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Email Address
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E-mail address of spouce
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Alternative Email Address
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Other Preferred Means of Communication? Please list here.
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Name of Emergency Contact
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Phone number of emergency contact --
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Sacramental Information
Baptized?
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Baptized Date //
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Marital Status
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Valid Catholic Marriage (if applicable)
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Date of Marrige //
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Reconciliation?
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Reconciliation Date //
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First Eucharist?
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First Eucharist Date //
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Confirmed?
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Confirmation Date //
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Dependent Children Information
Relationship to head of household
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Gender
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First Name
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Last Name
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Place of Birth
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Date of Birth //
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First Languge
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Catholic
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Baptised
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Date of Baptism (if applicable) //
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First Eucharist?
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First Eucharist Date //
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Reconciliation?
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Reconciliation Date //
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Confirmation?
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Confirmation Date //
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