Name *

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Birthdate *

MM

DD

YYYY

Mother's Name Including Maiden

First Name

Last Name

Father's Name

First Name

Last Name

Address of Baptismal Church

If you do not currently know the address, write "?"

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Baptism Date

Baptism Certificate or other proof will be required. If date currently unknown, write"?".

MM

DD

YYYY

If you were baptized in the Catholic Church, please check any other sacraments you have received.

Please provide copies of certificates.

First Communion

Penance(Confession)

Confirmation

I am living with my significant other *

Yes

No

I have a child/children with my current significant other *

N/A

Yes

No

Fiancé(e) Name

First Name

Last Name

For You

This is my first marriage

I have been married before

For Your Fiancé(e)

This is my fiancé's first marriage

My fiancé has been married before

Spouse's Name

First Name

Last Name

Is your spouse a baptized or fully initiated Catholic?

Yes

No