Reg Parish

Santa Clara Parish Registration

* Indicates required field

Do you wish to register at the Church or Chapel? *

Church Chapel

Head of Household First & Last Name *

First

Last

Name of Spouse *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Home Phone Number *

Cell Phone Number *

Email *

Do you wish to receive contribution envelopes? *

Yes No

Please list the names of your children and their birth dates, as well as any other Catholic member of your household:

(1) Name *

First

Last

Date of Birth (MM/DD/YYYY) *

(2) Name *

First

Last

Date of Birth (MM/DD/YYYY) *

(3) Name *

First

Last

Date of Birth (MM/DD/YYYY) *

(4) Name *

First

Last

Date of Birth (MM/DD/YYYY) *

(5) Name *

First

Last

Date of Birth (MM/DD/YYYY) *

(6) Name *

First

Last

Date of Birth (MM/DD/YYYY) *

Please include any additional questions or comments below. *

Thank you!

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