Family Last Name:  

Family Status:  Parishioners No Longer Parishioners - Please Remove Our Family from the Census New Family - Please Add Our Family Information to the Census

If you are no longer parishioners at St. John's, please complete the "Home Street Address" and "Home Phone" section below to ensure the correct family is removed from our records.

Home Street Address:     

City:    State:    Zip Code: 

Home Phone:     How would you like your mail to be addressed: Mr. & Mrs. Mr. Mrs. Ms. Miss Dr. Dr. & Mrs. Mr. & Dr.

Mailing Address (if different from home address):

Marital Status:  Married Single Divorced Separated Widowed    (If Married)        Marriage Date:   

Church:     City:     Was it a Catholic Ceremony: Yes No

Do you want to continue receiving your weekly church contribution envelopes?  Yes No

MALE HEAD OF HOUSE INFORMATION

First Name:    Middle Initial:    Preferred Name to be Called: 

Title:  Mr. Dr. Other   Other Title     Date of Birth:    Religion: 

Occupation:     Employer:   Job Title: 

E-Mail Address:     Work Phone:     Cell Phone: 

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

FEMALE HEAD OF HOUSE INFORMATION

First Name:    Middle Initial:    Preferred Name to be Called: 

Last Name (If different from Family Last Name): 

Title:  Mrs. Ms. Miss Dr. Other   Other Title     Date of Birth:    Religion: 

Occupation:     Employer:   Job Title: 

E-Mail Address:     Work Phone:     Cell Phone: 

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

CHILDREN UPDATE - Please complete the "Child Update" section below listing the oldest to youngest. Children away at college should be listed. Children 24 years or older are encouraged to register on their own at the Parish Office as an individual parish family.

CHILD # 1

First Name:    Middle Initial:      Sex:  Male Female

Last Name (If different from Family Last Name): 

Date of Birth:    Religion:     Lives at Home: Yes No Away at College

Current School:     Current Grade: Too Young - Still at Home Day Care Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade HS Freshman HS Sophomore HS Junior HS Senior College Freshman College Sophomore College Junior College Senior Graduate School  

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

CHILD # 2

First Name:    Middle Initial:      Sex:  Male Female

Last Name (If different from Family Last Name): 

Date of Birth:    Religion:     Lives at Home: Yes No Away at College

Current School:     Current Grade: Too Young - Still at Home Day Care Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade HS Freshman HS Sophomore HS Junior HS Senior College Freshman College Sophomore College Junior College Senior Graduate School  

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

CHILD # 3

First Name:    Middle Initial:      Sex:  Male Female

Last Name (If different from Family Last Name): 

Date of Birth:    Religion:     Lives at Home: Yes No Away at College

Current School:     Current Grade: Too Young - Still at Home Day Care Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade HS Freshman HS Sophomore HS Junior HS Senior College Freshman College Sophomore College Junior College Senior Graduate School  

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

CHILD # 4

First Name:    Middle Initial:      Sex:  Male Female

Last Name (If different from Family Last Name): 

Date of Birth:    Religion:     Lives at Home: Yes No Away at College

Current School:     Current Grade: Too Young - Still at Home Day Care Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade HS Freshman HS Sophomore HS Junior HS Senior College Freshman College Sophomore College Junior College Senior Graduate School  

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

CHILD # 5

First Name:    Middle Initial:      Sex:  Male Female

Last Name (If different from Family Last Name): 

Date of Birth:    Religion:     Lives at Home: Yes No Away at College

Current School:     Current Grade: Too Young - Still at Home Day Care Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade HS Freshman HS Sophomore HS Junior HS Senior College Freshman College Sophomore College Junior College Senior Graduate School  

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

CHILD # 6

First Name:    Middle Initial:      Sex:  Male Female

Last Name (If different from Family Last Name): 

Date of Birth:    Religion:     Lives at Home: Yes No Away at College

Current School:     Current Grade: Too Young - Still at Home Day Care Preschool Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade 8th Grade HS Freshman HS Sophomore HS Junior HS Senior College Freshman College Sophomore College Junior College Senior Graduate School  

Baptism: Yes No       First Communion:  Yes No      Confirmation:  Yes No

ADDITIONAL COMMENTS - Additional comments, questions, or concerns that you would like to pass on to Fr. Tim and the Pastoral Staff are welcome. Please use the box below for your comments. Thank you.

All information provided will be held in confidence, and will not be distributed (or sold) to outside sources. When you are finished, please press the "submit" button. Thank you.