New Parishioners

Date of Registration REQUIRED Please fill out this field. Please enter valid data.

Family Last Name REQUIRED Please fill out this field. Please enter valid data.

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.

Home Phone Number Please enter valid data.

Number of Adults REQUIRED
Anyone 18+
Please fill out this field.
Adult 1
- Sex REQUIRED Please fill out this field.
- Name: First, Middle, Last REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (If Applicable) Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- City/State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Email Please enter an email address.
- Occupation Please enter valid data.
- Marital Status REQUIRED Please fill out this field.
- Date of Marriage (If Applicable) Please enter valid data.
- Married By: (If applicable)
- Catholic REQUIRED Please fill out this field.
- Religion (If Not Catholic)
  If No Religion Indicate by typing "None"
  Please enter valid data.
- Sacrament Received (Please check all that apply) REQUIRED Baptized First Communion Reconciliation Confirmation None Please fill out this field.
- Mass Attendance REQUIRED Weekly Occasionally Seldom Never Please fill out this field.
Adult 2
- Sex REQUIRED Please fill out this field.
- Name: First, Middle, Last REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (If Applicable) Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- City/State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Email Please enter an email address.
- Occupation Please enter valid data.
- Marital Status REQUIRED Please fill out this field.
- Date of Marriage (If Applicable) Please enter valid data.
- Married By: (If applicable)
- Catholic REQUIRED Please fill out this field.
- Religion (If Not Catholic)
  If No Religion Indicate by typing "None"
  Please enter valid data.
- Sacrament Received (Please check all that apply) REQUIRED Baptized First Communion Reconciliation Confirmation None Please fill out this field.
- Mass Attendance REQUIRED Weekly Occasionally Seldom Never Please fill out this field.
Adult 3
- Sex REQUIRED Please fill out this field.
- Name: First, Middle, Last REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (If Applicable) Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- City/State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Email Please enter an email address.
- Occupation Please enter valid data.
- Marital Status REQUIRED Please fill out this field.
- Date of Marriage (If Applicable) Please enter valid data.
- Married By: (If applicable)
- Catholic REQUIRED Please fill out this field.
- Religion (If Not Catholic)
  If No Religion Indicate by typing "None"
  Please enter valid data.
- Sacrament Received (Please check all that apply) REQUIRED Baptized First Communion Reconciliation Confirmation None Please fill out this field.
- Mass Attendance REQUIRED Weekly Occasionally Seldom Never Please fill out this field.
Adult 4
- Sex REQUIRED Please fill out this field.
- Name: First, Middle, Last REQUIRED Please fill out this field. Please enter valid data.
- Maiden Name (If Applicable) Please enter valid data.
- Date of Birth (mm/dd/yyyy) REQUIRED Please fill out this field. Please enter valid data.
- City/State of Birth REQUIRED Please fill out this field. Please enter valid data.
- Cell Phone REQUIRED Please fill out this field. Please enter valid data.
- Email Please enter an email address.
- Occupation Please enter valid data.
- Marital Status REQUIRED Please fill out this field.
- Date of Marriage (If Applicable) Please enter valid data.
- Married By: (If applicable)
- Catholic REQUIRED Please fill out this field.
- Religion (If Not Catholic)
  If No Religion Indicate by typing "None"
  Please enter valid data.
- Sacrament Received (Please check all that apply) REQUIRED Baptized First Communion Reconciliation Confirmation None Please fill out this field.
- Mass Attendance REQUIRED Weekly Occasionally Seldom Never Please fill out this field.

Do you wish to give donations electronically? REQUIRED

Please consider having automatic payment mailed to St. Mary's from your bank. Our postal address is PO Box 2200, Jefferson, 01522. If you wish to receive envelopes instead you can receive your tax information upon request from the Office Manager, Sarah Brodie at 508-829-4508, or email her at [email protected]. If you choose "No", no envelopes will be sent and no tax information will be recorded.in our records

Yes No. Please mail me envelopes. No Please fill out this field.

Comments

Email REQUIRED Please fill out this field. Please enter an email address.

St. Mary's Catholic Church

Jefferson, MA

New Parishioner registration Form