Parish Registration Form Parish Registration Form Family Last Name * Mailing Name * Cell Phone Number * Home Number Email * Emergency Contact Name & relationship * Emergency Contact phone number * Couple/Head of Household Information Please give the correct information for the following First Name (s) * Address * Address Address Address City City State/Province State/Province Zip/Postal Zip/Postal Country Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Bulgaria Burkina Faso Burundi Côte d'Ivoire Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Curacao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthelemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Country Marital Status * Single Married Separated Divorced Widowed Children who are living at home with parents * YES NO I would like to receive Contribution Envelopes * YES NO I am interested in registering with Online Giving * YES NO https://giving.parishsoft.com/App/Giving/st140181 Do we have your permission to publish your family name in the “Welcome New Families” section of the bulletin/website? * YES NO Please check all that apply * Call from Clergy Call from Staff Visit for Sick or Homebound Family Member Adult Information Husband/Head * Husband/Head First First Last Last Date of Birth * Ethnicity * Please choose from dropdown White/Caucasian Black/African American HIspanic Korean Vietnamese Filipino Prefer not to respond First Language * English Spanish OtherOther Second Language English Spanish OtherOther Baptized – Roman Catholic * YES NO Baptized – Other Denomination * I have received the following Sacraments * First Eucharist Confirmation Matrimony Marriage Date * RCIA * YES NO Occupation Cell Phone * Email * Adult Information Wife * Wife First First Last Name Last Name Wife – Maiden Name * Date of Birth * Ethnicity * Please choose from dropdown White/Caucasian Black/African American HIspanic Korean Vietnamese Filipino Prefer not to respond First Language * English Spanish OtherOther Second Language English Spanish OtherOther Baptized – Roman Catholic * YES NO Baptized – Other Denomination * I have received the following Sacraments * First Eucharist Confirmation Matrimony RCIA * YES NO Occupation Cell Phone * Email * Children Information Name * Name First First Middle Middle Last Last Gender * Male Female Date of Birth * Place of Birth * Baptized – Roman Catholic * YES NO Reason for selecting No to Baptism * Need to schedule a baptism Other – DenominationOther – Denomination Please email a copy of baptism certificate with raised seal to info@stclarenj.org Has your child received other Sacraments * YES NO My child has received the following Sacraments * First Eucharist Confirmation Please email a copy of First Eucharist certificate with raised seal to info@stclarenj.org Is your child in Grades 1st thru 8th? * YES NO Are you interested in registering your child for any of the following programs? * Guardian Angels Catholic School Faith Formation Program Add Remove If you are human, leave this field blank. 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