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Parish Registration

- Info

Please fill out the form below to register for our parish. A packet of temporary envelopes will be sent to you shortly after registering. Please contact the parish office directly at 269-345-5147 with any questions.
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- Family Name REQUIRED Please fill out this field. Please enter valid data.
- Primary Address Information
- Address Please enter valid data.
- City Please enter valid data.
- State Please enter valid data.
- Zip Code Please enter valid data.
- Seasonal Address Information
- Address Please enter valid data.
- City Please enter valid data.
- State Please enter valid data.
- Zip Code Please enter valid data.
- Male Head of Household
- Head of Household First Name Please enter valid data.
- Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Occupation Please enter valid data.
- Email Please enter an email address.
- Preferred Phone Number Maximum 20 characters Please enter a phone number.
- Religion Catholic Other
- If other religion, please specify Please enter valid data.
- Sacraments Received- check all that apply Baptism First Reconciliation Confirmation First Eucharist Matrimony
- Date of Baptism and Location including Church and Address Please enter valid data.
- Date of Confirmation and Location including Church and Address Please enter valid data.
- Date of First Eucharist and Location including Church and Address Please enter valid data.
- Date of Marriage and Location including Church and Address Please enter valid data.
- Female Head of Household
- First Name Please enter valid data.
- Maiden Name REQUIRED Please fill out this field. Please enter valid data.
- Last Name Please enter valid data.
- Date of Birth Please enter a date.
- Occupation Please enter valid data.
- Email Please enter an email address.
- Preferred Phone Number Maximum 20 characters Please enter a phone number.
- Religion Catholic Other
- If other religion, please specify Please enter valid data.
- Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion Matrimony
- Date of Baptism and Location including Church and Address Please enter valid data.
- Date of Confirmation and Location including Church and Address Please enter valid data.
- Date of First Eucharist and Location including Church and Address Please enter valid data.
- Date of Marriage and Location including Church and Address Please enter valid data.
- Approximate Date Range your family resides in a seasonal location Please enter valid data.
- Would you like information on Electronic Giving? REQUIRED Yes No Please fill out this field.
- Number of Children REQUIRED Please fill out this field.
  
  Child 1
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 2
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 3
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 4
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 5
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 6
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 7
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 8
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 9
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 10
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 11
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
  
  Child 12
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Middle Name Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter a date.
  
  Sacraments Received- check all that apply Baptism Reconciliation Confirmation First Holy Communion
  
  Date of Baptism and Location including Church and Address Please enter valid data.
  
  Date of Confirmation and Location including Church and Address Please enter valid data.
  
  Date of First Eucharist and Location including Church and Address Please enter valid data.
  
  School Attending (if applicable) St. Augustine Cathedral Catholic School St. Monica Light of Christ Academy Hackett Catholic Prep Public School Home School Other
  
  If your child is not attending a school listed above, please specify the name of your school Please enter valid data.
  
  If your child is attending a public school or home school, are they attending our Religious Education Program? Yes No
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