Parish Registration

First Name

Middle Name

Last Name

Address

Phone 1

Phone 2

Email:

Select the church where you wish to register

Marital status

Single

Widow

Divorced

Married

Check the sacrament(s) you have received

Baptism

First Communion

Confirmation

If married, enter your spouse’s name

Please check the sacrament(s) your spouse has received

Baptism

First Communion

Confirmation

List your children living at home and any sacraments they have received

List your place of employment

If married, please list your spouse’s place of employment

Please use this space for any notes or special needs we may help you with

HEART OF PEORIA CATHOLIC COMMUNITY PARISH REGISTRATION