Parish Membership - Our Lady of LourdesCatholicChurch

Our Lady of LourdesCatholicChurch

8200 Woodman Road
Henrico Virginia 23228
Phone: 804-262-7315
Fax: 804-262-7337
el español: 804-262-7317

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Parish Membership Registration Form

Name *

First

Last

[object Object]

Head of household first Name *

Title *

Mr Mrs Ms

Suffix *

Sr Jr III

Other Title *

Other Suffix *

Marital Status *

Married Single Divorced Separated Widowed Engaged

Married Catholic *

Yes No Other-Recognized Catholic Marriage Other- Validated Catholic Marriage

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Home Number *

Cell Phone Number *

Sacrament Information

HEAD OF HOUSE *

M F

Name *

First

Last

Middle *

Language Spoken *

Race *

Date of Birth *

Religion *

Catholic Other

If other, fill in religion below *

Name of Church of Baptism *

Address of Church of Baptism *

Line 1

Line 2

City

State

Zip Code

Country

Church of 1st Communion *

Address of 1st Communion *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Confirmation *

Address of Church of Confirmation *

Line 1

Line 2

City

State

Zip Code

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SPOUSE *

M F

Name *

First

Last

Middle

Middle *

Language Spoken *

Race *

Date of Birth *

Religion *

Catholic Other

If other, fill in religion below *

Name of Church of Baptism *

Address of Church of Baptism *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of 1st Communion *

Address of Church of 1st Communion *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Confirmation *

Address of Church of Confirmation *

Line 1

Line 2

City

State

Zip Code

Country

CHILD'S NAME *

First

Last

[object Object]

Middle *

* *

M F

Religion *

Catholic Other

Grade *

Name of School *

Language Spoken *

Race *

Date of Birth *

Name of Church of Baptism *

Address of Church of Baptism *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of 1st Communion *

Address of Church of 1st Communion *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Confirmation *

Address of Church of Communion *

Line 1

Line 2

City

State

Zip Code

Country

CHILD'S NAME *

First

Last

[object Object]

Middle *

-- *

M F

Religion *

Catholic Other

Grade *

Name of School *

Language Spoken *

Race *

Date of Birth *

Name of Church of Baptism *

Address of Church of Baptism *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of 1st Communion *

Address of Church of 1st Communion *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Confirmation *

Address of Church of Confirmation *

Line 1

Line 2

City

State

Zip Code

Country

CHILD'S NAME *

First

Last

[object Object]

Middle *

* *

M F

Religion *

Catholic Other

Grade *

Name of School *

Language Spoken *

Race *

Date of Birth *

Name of Church of Baptism *

Address of Church of Baptism *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of 1st Communion *

Address of Church of 1st Communion *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Confirmation *

Address of Church of Confirmation *

Line 1

Line 2

City

State

Zip Code

Country

CHILD'S NAME *

First

Last

[object Object]

Middle *

* *

M F

Religion *

Catholic Other

Grade *

Name of School *

Language Spoken *

Race *

Date of Birth *

Name of Church of 1st Communion *

Address of Church of 1st Communion *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Confirmation *

Address of Church of Confirmation *

Line 1

Line 2

City

State

Zip Code

Country

Name of Church of Baptism *

Address of Church of Baptism *

Line 1

Line 2

City

State

Zip Code

Country

Submit

Our Lady of Lourdes Catholic Church
8200 Woodman Road
Henrico, VA 23228

Phone: 804.262.7315
Fax: 804.262.7337

el español: 804-262-7317
el español: 804-262-7317

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