REGISTRATION FORM


Register for the St. Robert Bellarmire On-Line
Head of Household

Name (First, Middle, Last):
Maiden Name:

Familiar Name:

E-Mail:

Male/Female: Birth Date: (month) (day) (year)

Street Address:
City: Zip:

Subdivision:

Home Phone (please include area): Is this number unlisted?

Marital Status: Catholic Marriage?
Church/Place:

Religious Preference: Baptized? First Communion? Confirmation?

Occupation: Employer:

Work Phone (please include area):

Cell Phone/Pager Number (please include area):
E-mail address:

 

Spouse

Name (First, Middle, Last):
Maiden Name:

Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized?
First Communion? Confirmation?

Occupation: Employer:

Work Phone (please include area):

Cell Phone/Pager Number (please include area):
E-mail address:

 

Children Under 18 - (Oldest Child First)

1. Name (First, Middle, Last):
Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized?
First Communion? Confirmation?

School Attending:
Grade:

 

2. Name (First, Middle, Last):
Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized?
First Communion? Confirmation?

School Attending:
Grade:

 

3. Name (First, Middle, Last):
Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized?
First Communion? Confirmation?

School Attending:
Grade:

 

4. Name (First, Middle, Last):
Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized?
First Communion? Confirmation?

School Attending:
Grade:

 

5. Name (First, Middle, Last):
Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized? First Communion? Confirmation?

School Attending:
Grade:

 

Other Adult

Name (First, Middle, Last):
Familiar Name:

Male/Female: Birth Date: (month) (day) (year)

Religious Preference: Baptized?
First Communion? Confirmation?

Occupation: Employer:







"A Parish
with a
Family
Perspective"
1424 First Capitol Drive South  I  St. Charles, Missouri 63303  I  636-946-6799