Name *

First Name

Last Name

Date of Birth *

MM

DD

YYYY

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Work Phone

(###)

###

####

Have you been baptized? *

No

Yes

If baptized Catholic, did you make First Holy Communion?

Yes

No

Not Sure

Have you participated in another Church? *

Yes

No

What prompted you to come to these sessions at this time

I definitely want to become a Catholic.

I think I might want to become a Catholic.

I'm just looking - Not sure at this time.

I'm just curious about what Catholics believe.

I don't want to join - just want to know more about the Catholic Church.

Please check all that apply:

I'm presently engaged.

I am presently married.

My spouse is Catholic.

I am presently separated.

I am divorced and remarried.

My first spouse is deceased.

I am divorced but not remarried.

I have never been married in the Catholic Church.

I have been married only once.

I was married before.

I have been divorced more than once.

I am a widow/widower.

I have my annulment papers

Yes - Complete

Not yet - In process

No - Never Started Process

Does not apply

Name of Spouse

First Name

Last Name

Is there any Catholic friend that you would like to have as a sponsor*? If yes, list their info below. *

You must choose a sponsor to share in your Faith Journey. They must be a Confirmed Catholic, in good standing, and able to receive Holy Communion. An updated Baptismal Certificate is required from his/her church of baptism.

Yes

No

Not Sure

Are you attending Mass regularly? *

Yes

No