FAMILY NAME ______________________________________________________________________

ST. DENNIS PARISH CENSUS INFORMATION

ADDRESS: __________________________________________________________________________________________________
CITY/STATE/ZIP: __________________________________________________________________________________________
HOME PHONE NUMBER: ________________________________________________________________________________
FAMILY E-MAIL ADDRESS: ______________________________________________________________________________

TODAYS DATE: _____________________

Envelope No. _________________________
I/We would like information on:
_____ RCIA
_____ Baptism
_____ School
_____ GIFTs Program
_____ Blessing of Marriage
_____ Blessing of Home

FAMILY STATUS please circle one: Single, Married, Divorced, Remarried, Widow/Widower, Engaged
HUSBANDS FIRST NAME: ________________________________________

PREFERRED NICK NAME: ______________________________________________________

CELL PHONE: ______________________________________________________

E-MAIL ADDRESS: _______________________________________________________________

BIRTH DATE: ______________________________________________________

OCCUPATION: __________________________________________________________________

WHERE EMPLOYED: ______________________________________________

BUSINESS PHONE: ______________________________________________________________

DO YOU SPEAK A 2ND LANGUAGE? ___________________________

IF YES, WHICH ONE? ___________________________________________________________

RELIGION: __________________________________________________________

SACRAMENTS: Please indicate YES or NO

BAPTISM __________

1st COMMUNION __________

CONFIRMATION __________

MARRIED BY PRIEST/DEACON__________

CHURCH OF MARRIAGE: ________________________________________

DATE OF MARRIAGE: __________________________________________________________

WIFEs FIRST NAME: _____________________________________________

WIFEs MAIDEN NAME: ________________________________________________________

CELL PHONE: ______________________________________________________

E-MAIL ADDRESS: _______________________________________________________________

BIRTH DATE: ______________________________________________________

OCCUPATION: __________________________________________________________________

WHERE EMPLOYED: ______________________________________________

BUSINESS PHONE: ______________________________________________________________

DO YOU SPEAK A 2ND LANGUAGE? ___________________________

IF YES, WHICH ONE? ___________________________________________________________

RELIGION: __________________________________________________________

SACRAMENTS: Please indicate YES or NO

BAPTISM __________
(over)

1st COMMUNION __________

CONFIRMATION __________

MARRIED BY PRIEST/DEACON__________

CHILDREN LIVING AT SAME ADDRESS

Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: _____________ Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
Childs Name ____________________________
Birth Date _________________
Male / Female _____
School Name ___________________________ Grade _______
Sacraments: Yes or No BAPTISM: Date / Church ___________________________________
1st Communion: Date / Church __________________ Confirmation: Date / Church _________________
OTHER ADULTS LIVING AT SAME ADDRESS (PARENTS/IN-LAWS/SIBLINGS)
NAME: ___________________________________________________ BIRTH DATE: _______________
HOW RELATED?____________________________________________ Special Needs (if any) _______________
Please use another sheet of paper if needed:
How can we help you? Do you have any particular needs at this time, ie., Home-bound visits, nursing home visits, etc.
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
Would you share your talents/time with us? Please check the Ministry description/signup sheets. _______________________
_____________________________________________________________________________________________________