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Divine Mercy

Become a Member of our parish

New Parishioner Form

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Is this registration for an individual or members of a household? *

Individual
Household

Household Information

Number of Adults: *

One
Two

Number of Dependants

Selected Value: 0

How many dependants within your household will you also be registering with the parish?

Name: *

Common name used to recognize members of the household.

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Home Phone Number: *

First Adult Information

ADULT 1 - Full Name: *

First

Last

The preferred name for you or the first adult in the household.

ADULT 1 - Date of Birth: *

ADULT 1 - Preferred Phone Number:

If different from home phone number

ADULT 1 - Email: *

ADULT 1 - Sacraments received:

Baptism
Confirmation
Holy Eucharist
Reconciliation
Matrimony

ADULT 1 - Would You be Interested in Volounteering/Serving:

At one of our Sunday Masses
In the Parish

ADULT 1 - Would you like donations envelopes?

Yes
No

ADULT 1 - Further Email Communications:

I would like to join the Divine Mercy Parish mailing list

Second Adult Information

ADULT 2 - Full Name *

First

Last

The preferred name for the second adult in the family.

Date / Time

ADULT 2 - Preferred Phone Number:

If different from the home phone number.

ADULT 2 - Email:

ADULT 2 - Sacraments received:

Baptism
Confirmation
Holy Eucharist
Reconciliation
Matrimony

ADULT 2 - Would You be Interested in Volunteering/Serving:

At one of our Sunday Masses
In the Parish

ADULT 2 - Would you like donation envelopes?

Yes
No

ADULT 2 - Further Email Communications:

I would like to join the Divine Mercy Parish mailing list

First Dependant Information

DEPENDANT 1 - Name *

First

Last

DEPENDANT 1 - Date of Birth

DEPENDANT 1 - Sacraments Received:

Baptisim
Confirmation
Holy Eucharist
Reconciliation

Second Dependant Information

DEPENDANT 2 - Name *

First

Last

DEPENDANT 2 - Date of Birth

DEPENDANT 2 - Sacraments Received:

Baptisim
Confirmation
Holy Eucharist
Reconciliation

Third Dependant Information

DEPENDANT 3 - Name *

First

Last

DEPENDANT 3 - Date of Birth

DEPENDANT 3 - Sacraments Received:

Baptisim
Confirmation
Holy Eucharist
Reconciliation

Fourth Dependant Information

DEPENDANT 4 - Name *

First

Last

DEPENDANT 4 - Date of Birth

DEPENDANT 4 - Sacraments Received:

Baptisim
Confirmation
Holy Eucharist
Reconciliation

Fifth Dependant Information

DEPENDANT 5 - Name *

First

Last

DEPENDANT 5 - Date of Birth

DEPENDANT 5 - Sacraments Received:

Baptisim
Confirmation
Holy Eucharist
Reconciliation

Sixth Dependant Information

DEPENDANT 6 - Name *

First

Last

DEPENDANT 6 - Date of Birth

DEPENDANT 6 - Sacraments Received:

Baptisim
Confirmation
Holy Eucharist
Reconciliation

Notes or comments

If you have special allergies, accessibility requirements, more than four dependants or other concerns - please let us know!

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