RCIA Registration

Name*

Prefix First Middle Last Suffix

Maiden Name (if applicable):

Address*

Street Address City State / Province / Region ZIP / Postal Code

Email*

Cell Phone*

Place of Birth*

Date of Birth*

Occupation*

What, if any, is your present religious affiliation?*

Have you ever been baptized?*

Yes
No
I am not sure.

In what denomination were you baptized?*

Approximate date when you were baptized*

Place of Baptism (Name of Church)*

Address, if known

Street Address City State / Province / Region ZIP / Postal Code Country

If you were baptized as a Catholic, check those sacraments you have already received

Penance (Confession)
Eucharist (First Communion)
Confirmation

What is your current marital status?

Your Fiancee's Name*

First Last

Your fiancee's current religious affiliation (if any):*

Your Spouse's Name*

First Last

Your spouse's current religious affiliation (if any):*

For you:*

This is my first marriage.
I have been married before.

For Your Fiancee:*

This is his/her first marriage.
He/she has been married before.

For your spouse:*

This is his/her first marriage.
He/she has been married before.

Appoximate Date of Proposed Marriage*

Date of Marriage*

Place of Marriage*

Name of Place of Marriage City State / Province / Region ZIP / Postal Code Country

Your Father's Name*

First Last

Your Father's Religious Affiliation*

Your Mother's Name*

First Maiden Name

Your Mother's Religious Affiliation*

How many children do you have?*

Child #1 Name*

First Last

Child #1 Age*

Please enter a number from 0 to 100.

Child #2 Name*

First Last

Child #2 Age*

Please enter a number from 0 to 100.

Child #3 Name*

First Last

Child #3 Age*

Please enter a number from 0 to 100.

Child #4 Name*

First Last

Child #4 Age*

Please enter a number from 0 to 100.

RCIA Inquirer Form