Reg Date:
Corpus Christi Parish
Family Registration
880 Toyopa Dr., Pacific Palisades, CA 90272 (310) 454-1328
Last Name:
First Name(s):
Mailing Name (ie Mr. & Mrs. John Doe)
Address:
Add2:
City:
State:
Zip:
-
AreaCode:
Home Phone:
Emerg.
Phone:
Family Email:
Env#:
Individual Member Information
Parish Status:
(Active,
Inactive)
Active
Inactive
Active
Inactive
Role:
(Head of House,
Husband, Wife etc.)
First Name / Nickname:
/
/
Gender:
Male
Female
Male
Female
DOB (mm/dd/yyyy):
Maiden Name:
Email:
Work Phone/Cell Phone:
/
/
First Language:
Occupation/Employer:
Sacramental Info:
Baptized?
Catholic?
Baptized?
Catholic?
Dates (mm/dd/yyyy):
(Single, Married, Separated, Divorced, Annulled)
Reconcil?
First Eucharist?
Confirmed?
Reconcil?
First Eucharist?
Confirmed?
Marital Status:
Valid Catholic Marriage?
Are there any members of your household who would like to be visited by a priest?
Relationship to
Head of
Household
Dependent Children Information
First Name / Last Name
Gender
Birthdate
& Birthplace
H.S.
Grad Yr
School
First Language
(Son, Daughter, Mother Father etc.)
1.
M
F
Check if Sacrament Received.
Add Date if known.
Baptism
Catholic?
Eucharist
Reconciliation
Confirmation
2.
M
F
Check if Sacrament Received.
Add Date if known.
Baptism
Catholic?
Eucharist
Reconciliation
Confirmation
3.
M
F
Check if Sacrament Received.
Add Date if known.
Baptism
Catholic?
Eucharist
Reconciliation
Confirmation
Submit
Please fill in all blank boxes and provide changes where necessary. If need to add additional members please use a second form.