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Parish Registration Form Holy Cross Catholic Church 405 West Clark Street, Champaign, Illinois 61820 PHONE: (217) 352-8748 FAX: (217) 366-2929 E-MAIL: office@holycrosschampaign.org Family Name: _______________________________________ Date ___________________ Previously Registered: Yes/No How would you like to be addressed on correspondence? _____________________________________________________

HUSBAND OR SINGLE MALE HEAD OF THE HOUSEHOLD: First & Middle Name _______________________________

Home Phone ____________________________________

Last Name

Cell Phone

_____________________________________

____________________________________

Street Address

_________________________________

Work Phone ____________________________________

City & Zip Code

_________________________________

E-Mail

____________________________________

Religion

_____________________________________

Date of Birth ____________________________________

Employer

_____________________________________

Occupation

Sacraments Received:

□ Baptism

□ Eucharist

□ Confirmation

____________________________________

□ Marriage

□ Holy Orders

WIFE OR SINGLE FEMALE HEAD OF HOUSEHOLD: First & Middle Name _______________________________

Home Phone ____________________________________

Last Name

Cell Phone

_____________________________________

____________________________________

Maiden Name

_________________________________

Work Phone ____________________________________

Street Address

_________________________________

E-Mail

City & Zip Code __________________________________ Religion

_____________________________________

Employer

_____________________________________

Sacraments Received:

□ Baptism

□ Eucharist

Would you like to meet with Fr. Steve Willard? Yes

____________________________________

Date of Birth ____________________________________

Occupation

□ Confirmation

____________________________________

□ Marriage

□ Holy Orders

No

Marriage Information: Date of Marriage ______________________________________________________________________________________ Location: Church City & State ____________________________________________________________________________

In the Catholic Church

Is this your first marriage?

Out of the Catholic Church

Husband: Yes/No

Out of the Catholic Church with Dispensation

Wife: Yes/No

Children or Other Dependents Living at Home: Name

For Office Use: EI

Sex

ES

W

Birthday

WN

Religion

O

Baptized?

Communion?

Confirmed?

School & Grade

Envelope # _________________


parish-registration-form  

Sacraments Received: □ Baptism □ Eucharist □ Confirmation □ Marriage □ Holy Orders For Office Use: EI ES W WN O Envelope # _________________...

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