Register Online Step 1 of 5 20% Your Name(Required) Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. M/M, Ms., Mr., etc. First Middle Initial Last Spouse's Name Dr.MissMr.Mrs.Ms.Mx.Prof.Rev. M/M, Ms., Mr., etc. First Middle Initial Last Previously Registered under parents name Yes No Address Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Marital Status(Required)Please check all that apply Married Single Divorced Separated Widowed How were you married?Please check all that apply Married by Catholic priest Married by minister with proper dispensation Married by justice of peace or minister without dispensation Mass Attendance Weekly Daily Occasionally Seldom Holy Communion Weekly Daily Occasionally Seldom Home Phone(Required)Cell PhoneEmail If you were married outside the Church, would you like to have your marital status reviewed? Yes No If there is a person who is not a Catholic in your household, would he/she like to learn more about the Catholic Church? Yes No Would you be interested in information about St. James School and/or other Catholic schools in Broome County? Yes No Please list talents and skills(e.g. carpenter, child care, computer expert, electrician, financial expert, musical instrument, vocalist, nurse, plumber, teacher, artist, secretary, public relations, librarian, etc.) click the plus (+) button on the right to add more lines Add RemovePlease indicate any special needs of anyone in your family(such as aged, housing, medical, employment, occupational training, day nursery care, or other) Please be specific. click the plus (+) button on the right to add more lines Add Remove HusbandName(Required) First Last name if different/ maiden name of wife DisabilityReligionOccupationFull or Part time Full time Part time EmployerSchool AttendingBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date WifeName(Required) First Last name if different/ maiden name of wife DisabilityReligionOccupationFull or Part time Full time Part time EmployerSchool AttendingBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Single AdultName(Required) First Last name if different/ maiden name of wife Sex Male Female DisabilityReligionOccupationFull or Part time Full time Part time EmployerSchool AttendingBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Child InformationDo you have children? Yes No Child #1Name(Required) First Last name if different/ maiden name of wife Sex Male Female DisabilityReligionOccupationFull or Part time Full time Part time EmployerSchool AttendingBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Add a second child? Yes No Child #2Name(Required) First Last name if different/ maiden name of wife Sex Male Female DisabilityReligionOccupationFull or Part time Full time Part time EmployerBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Add a third child? Yes No Child #3Name(Required) First Last name if different/ maiden name of wife Sex Male Female DisabilityReligionOccupationFull or Part time Full time Part time EmployerSchool AttendingBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Add a fourth child? Yes No Child #4Name(Required) First Last name if different/ maiden name of wife Sex Male Female DisabilityReligionOccupationFull or Part time Full time Part time EmployerSchool AttendingBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Add a fifth child? Yes No Child #5Name(Required) First Last name if different/ maiden name of wife Sex Male Female DisabilityReligionOccupationFull or Part time Full time Part time EmployerBirth Date AgeBaptism Yes No Baptism Date Penance Yes No Penance Date First Holy Communion Yes No First Holy Communion Date Confirmation Yes No Confirmation Date Marriage Yes No Marriage Date Presently receiving religious education Yes No Presently receiving religious education date Ministries in previous Parish Δ
