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- - Parish Deceased 2023
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- About Us

Membership Form

Please complete the following information for the head of the household.

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- Head of Household
  
  First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Religion REQUIRED Please fill out this field. Please enter valid data.
  
  Date of Birth REQUIRED Please fill out this field. Please enter valid data.
  
  Marital Status REQUIRED Please fill out this field.
  
  Street Address REQUIRED Please fill out this field. Please enter valid data.
  
  City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
  
  Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mobile Phone Maximum 20 characters Please enter a phone number.
  
  Email Please enter an email address.
  
  Do you wish to receive church envelopes? REQUIRED Yes No Please fill out this field.
- Spouse Information
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Religion Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Mobile Phone Maximum 20 characters Please enter a phone number.
  
  Email Please enter an email address.
- Additional Household Adults REQUIRED Please fill out this field.
  
  Adult 1
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  Email Please enter an email address.
  
  Mobile Phone Maximum 20 characters Please enter a phone number.
  
  Adult 2
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  Email Please enter an email address.
  
  Mobile Phone Maximum 20 characters Please enter a phone number.
  
  Adult 3
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  Email Please enter an email address.
  
  Mobile Phone Maximum 20 characters Please enter a phone number.
  
  Adult 4
  
  First Name Please enter valid data.
  
  Last Name Please enter valid data.
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  Email Please enter an email address.
  
  Mobile Phone Maximum 20 characters Please enter a phone number.
- Number of Children in Household REQUIRED Please fill out this field.
  
  Child 1
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 2
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 3
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 4
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 5
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 6
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 7
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 8
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 9
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
  
  Child 10
  
  Child Name Please enter valid data.
  
  Gender Male Female
  
  Date of Birth Please enter valid data.
  
  Religion Please enter valid data.
  
  School Child Attends Please enter valid data.
- Sacraments Received Baptism Reconciliation Holy Communion Confirmation
- Parish of Baptism (if applicable)
  
  Parish of Baptism Please enter valid data.
  
  City Please enter valid data.
  
  State
  
  Zip Please enter a zip code.
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St. Peter Catholic Church
P. O. Box 435, 1550 Highway 44 | Reserve LA, 70084
Phone: 985-536-2887 | Fax: 985-536-7078 | Email: [email protected]

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