ST ALOYSIUS CATHOLIC CHURCH and
MARY STAR OF THE SEA MISSION

70 School Street. PO Box 66, Point Arena, CA 95468
707-882-1734

REGISTRATION FORM

Family Last Name:

Home Address:

City:

Zip Code:

Phone:

Church Attendance: Regular Frequent Occasional Seldom

Present Marital Status:	Married in the Catholic Church Married but not in the Catholic Church Divorced Separated Widowed Single Living Together
	Year:

A Head of Household:

Date of Birth:

Occupation:

Work Phone:

Place of Employment:

Cell Phone:

Email:

Religion:

Maiden Name
(If applicable):

Spouse/Domestic Partner:

Date of Birth:

Occupation:

Work Phone:

Place of Employment:

Cell Phone:

Email:

Religion:

Maiden Name
(If applicable):

Name	M / F	DOB	Baptism	Communion	Confirmation	Present Grade	Special Needs
SACRAMENTAL INFORMATION OF ALL MEMBERS LIVING IN SAME HOUSEHOLD (Include Head of Household, Spouse, Children, Others in the Household)
	/
	/
	/
	/
	/
	/
	/

Is there anyone in the household who is homebound? Yes No

Primary language(s) spoken in the household

Preferred method of contributions to the parish: Envelopes Electronic funds transfer

Anything Else?