Parish Registration Form

 

Parish Registration



Please fill out this form in order to join our parish. Be sure to let the parish
you are moving from know that you have joined our parish.

Welcome to Our Lady of the Mount!

[contact-form to=’APerry@olmcc.com’ subject=’Parish Registration Form’][contact-field label=’Family Last Name’ type=’name’ required=’1’/][contact-field label=’Address’ type=’textarea’ required=’1’/][contact-field label=’City’ type=’text’ required=’1’/][contact-field label=’Zip ‘ type=’text’ required=’1’/][contact-field label=’Home Phone’ type=’text’ required=’1’/][contact-field label=’Mobile Phone’ type=’text’ required=’1’/][contact-field label=’Emergency Phone (other than family listed)’ type=’text’ required=’1’/][contact-field label=’Head of Household Last Name’ type=’text’ required=’1’/][contact-field label=’Head of Household First Name’ type=’text’ required=’1’/][contact-field label=’Head of Household Middle Name’ type=’text’ required=’1’/][contact-field label=’Head of Household Date of Birth’ type=’text’/][contact-field label=’Head of Household Marital Status’ type=’select’ required=’1′ options=’Married,Single,Widowed,Seperated,Divorced’/][contact-field label=’Has been Baptized’ type=’checkbox’/][contact-field label=’Has received First Communion’ type=’checkbox’/][contact-field label=’Has been Confirmed’ type=’checkbox’/][contact-field label=’Marriage by Catholic Priest’ type=’checkbox’/][contact-field label=’Head of Household Email’ type=’email’/][contact-field label=’Head of Household Occupation’ type=’text’/][contact-field label=’Head of Household Business Name’ type=’text’/][contact-field label=’Head of Household Business Address’ type=’textarea’/][contact-field label=’Head of Household Business Phone’ type=’text’/][contact-field label=’Spouse Last Name’ type=’text’/][contact-field label=’Spouse First Name’ type=’text’/][contact-field label=’Spouse Middle Name’ type=’text’/][contact-field label=’Spouse Maiden Name’ type=’text’/][contact-field label=’Spouse Date of Birth’ type=’text’/][contact-field label=’Spouse Marital Status’ type=’select’ options=’None,Married,Single,Widowed,Separated,Divorced’/][contact-field label=’Has been Baptized’ type=’checkbox’/][contact-field label=’Has received First Communion’ type=’checkbox’/][contact-field label=’Has been Confirmed’ type=’checkbox’/][contact-field label=’Date of Marriage’ type=’text’/][contact-field label=’Spouse Email’ type=’text’/][contact-field label=’Spouse Occupation’ type=’text’/][contact-field label=’Spouse Business Name’ type=’text’/][contact-field label=’Business Address’ type=’textarea’/][contact-field label=’Spouse Business Phone’ type=’text’/][contact-field label=’1st Child/Other Member Name’ type=’text’/][contact-field label=’1st Child/Other Member Gender’ type=’radio’ options=’Male,Female’/][contact-field label=’1st Child/Other Member Date of Birth’ type=’text’/][contact-field label=’1st Child/Other Member School Attending’ type=’text’/][contact-field label=’1st Child/Other Member Grade’ type=’text’/][contact-field label=’Has been Baptized’ type=’checkbox’/][contact-field label=’Has received First Communion’ type=’checkbox’/][contact-field label=’Has been Confirmed’ type=’checkbox’/][contact-field label=’2nd Child/Other Member Name’ type=’text’/][contact-field label=’2nd Child/Other Member Gender’ type=’radio’ options=’Male,Female’/][contact-field label=’2nd Child/Other Member Date of Birth’ type=’text’/][contact-field label=’2nd Child/Other Member School Attending’ type=’text’/][contact-field label=’2nd Child/Other Member Grade’ type=’text’/][contact-field label=’Has been Baptized’ type=’checkbox’/][contact-field label=’Has received First Communion’ type=’checkbox’/][contact-field label=’Has been Confirmed’ type=’checkbox’/][contact-field label=’3rd Child/Other Member Name’ type=’text’/][contact-field label=’3rd Child/Other Member Gender’ type=’radio’ options=’Male,Female’/][contact-field label=’3rd Child/Other Member Date of Birth’ type=’text’/][contact-field label=’3rd Child/Other Member School Attending’ type=’text’/][contact-field label=’3rd Child/Other Member Grade’ type=’text’/][contact-field label=’Has been Baptized’ type=’checkbox’/][contact-field label=’Has received First Communion’ type=’checkbox’/][contact-field label=’Has been Confirmed’ type=’checkbox’/][contact-field label=’4th Child/Other Member Name’ type=’text’/][contact-field label=’4th Child/Other Member Gender’ type=’radio’ options=’Male,Female’/][contact-field label=’4th Child/Other Member Date of Birth’ type=’text’/][contact-field label=’4th Child/Other Member School Attending’ type=’text’/][contact-field label=’4th Child/Other Member Grade’ type=’text’/][contact-field label=’Has been Baptized’ type=’checkbox’/][contact-field label=’Has received First Communion’ type=’checkbox’/][contact-field label=’Has been Confirmed’ type=’checkbox’/][contact-field label=’Are there any other adults in your household?’ type=’radio’ options=’Yes,No,No’/][contact-field label=’Do you have children in grades 1 through 8 who are not attending a Catholic School?’ type=’radio’ options=’Yes,No’/][contact-field label=’Is there a person in your home who is Bedridden?’ type=’checkbox’/][contact-field label=’Is there a person in your home who has Special Learning Needs’ type=’checkbox’/][contact-field label=’Is there a person in your home who is Confined to Home’ type=’text’/][contact-field label=’Is there a person in your home who is Deaf’ type=’checkbox’/][contact-field label=’Is there a person in your home who is Blind’ type=’checkbox’/][contact-field label=’Is there a person in your home who is Physically Handicapped’ type=’text’/][contact-field label=’Do you receive church envelopes?’ type=’radio’ options=’Yes,No’/][contact-field label=’Do you have a special need you would like to discuss with a priest?’ type=’radio’ options=’Yes,No’/][bws_google_captcha] [/contact-form]

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