Parish Registration

Date of Registration REQUIRED Please fill out this field. Please enter a date.

Preferred Language? REQUIRED English Español Please fill out this field.

Have you registered at Ss. Simon & Jude before? REQUIRED Yes No Please fill out this field.

If so, when? Please enter valid data.

Head of Household Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.
Email REQUIRED Please fill out this field. Please enter an email address.
Primary Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Homebound? REQUIRED Yes No Please fill out this field.
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.
Preferred Giving Method REQUIRED
Please choose only one Preferred Giving Method
Electronic Giving (click link below to sign up) Envelopes (Pick up Envelopes at Parish Office) Please fill out this field.
To sign up for Electronic Giving please click here or pick up your envelopes in the Parish office
Marital Status REQUIRED Married by Catholic Church Civil Marriage Single Separated Divorced Widow/ed Other Please fill out this field.

Sacraments

Please check the sacraments you or your family have received, only include those living with you. 18 years of age and older must register as a separate family.

Head of Household

Full Name REQUIRED Please fill out this field. Please enter valid data.
Sex REQUIRED Male Female Please fill out this field.
Birthday REQUIRED Please fill out this field. Please enter a date.
Cell Phone REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
Email REQUIRED Please fill out this field. Please enter an email address.
Occupation REQUIRED Please fill out this field. Please enter valid data.
Sacraments (check all that apply) Catholic Baptism Communion Confirmation

Spouse

Child 2

Child 3

Child 4

Child 5

Child 6

Version en Español