ST. HENRY PARISH REGISTRATION FORM 6696 Springboro Pike Dayton, Ohio 45449 (937) 434-9231 Office Hours M-F 9am-4pm Family Last Name: Address: City, State, ZIP: Phone: Email: First Name/Initial (Head of Household): Date of Birth: First Name/Initial (Spouse/Other): Maiden (if applicable): Date of Birth: How would you like your mail addressed? (ie. Mr. and Mrs. Michael & Mary Smith) Date Registered in Parish: (Today's Date) Marital Status: Single Married Widowed Divorced Remarried Marriage Date: Church: City/State of Marriage: Married by a Priest? Yes No Convalidated Envelope Number: (Office will supply number) Religious Affiliation: Head of Household Catholic Other (specify) Spouse/Other Catholic Other (specify) Head of Household Employer: Title: Phone: Spouse Employer: Title: Phone: Children: (please list if at home, incollege, or in service) List First Name, Initial, Last (if different), DOB, School: 1. 2. 3. 4. SACRAMENTAL STATUS: (check if applicable) HOH: Baptism First Penance First Communion Confirmation Attends Mass Regularly Spouse: Baptism First Penance First Communion Confirmation Attends Mass Regularly Child 1: Baptism First Penance First Communion Confirmation Attends Mass Regularly Child 2: Baptism First Penance First Communion Confirmation Attends Mass Regularly Child 3: Baptism First Penance First Communion Confirmation Attends Mass Regularly Child 4: Baptism First Penance First Communion Confirmation Attends Mass Regularly (For office use only: Comp____ Census____ AFD____ Env____ )
HOH: Baptism First Penance First Communion Confirmation Attends Mass Regularly
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