Parishioner Registration Form

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

Home Phone: Please enter a phone number.

Cell Phone: REQUIRED Please fill out this field. Please enter a phone number.

Address: REQUIRED Please fill out this field. Please enter valid data.

Mailing Address (if different): Please enter valid data.

Family Salutation: Please enter valid data.

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

SPS School Family: REQUIRED Yes No Please fill out this field.

List all persons living at the above address. Adults living with their children may register as an individual or as part of the above family. Larger families should fill out a 2nd form.

Household Members REQUIRED Please fill out this field.
Member 1
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.
Member 2
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.
Member 3
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.
Member 4
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.
Member 5
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.
Member 6
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.
Member 7
- Role REQUIRED Please fill out this field.
- First and Middle Name REQUIRED Please fill out this field. Please enter valid data.
- Last and Maiden (and/or family namer if different from above) Please enter valid data.
- Date of Birth REQUIRED Please fill out this field. Please enter a date.
- Relationship Please enter valid data.
- Religion Please enter valid data.
- Sacraments recieved Baptism Communion Confirmation
- Date Married, Church Name, City and State Please enter valid data.

Parish Offering:

I would like to participate in the WeShare online contribution system. REQUIRED Please fill out this field.

I would like to be placed on the envelope system for contributions. REQUIRED Please fill out this field.

St. Patrick's Church

Serving Yorktown's Catholic COmmunity for Over 125 Years

Parishioner Registration Form