Church Of Our Lady
5225 Refugee Road
Columbus, Ohio 43232-5398

C-12

Your Email Address: (required)

Family Registration Form - English

Last Name: (required)
First Name(s): (required)
Mailing Name: (required - ie: Mr. & Mrs. John Doe)

Home Address (required):
Mailing Address: (ie: PO Box)
Other Address: (ie: snowbirds)

Family Status: (required) ActiveInactive

Home Phone Number: (required)
Emergency Phone Number:
Previous Parish:

Individual Member Information

Male Adult

Role: (Head of household, Husband, wife etc.. required)
First Name/Nickname: (required)
DOB: (required)
Special Needs:
First Language:
Second Language:
Ethnic Origin:
School:
Education Level:
Occupation:
Employer:
Work Phone:
Cell Phone:
Sacramental Info:
Catholic
RCIA
RCIA Date:
If Other Religion:
Baptism
Baptism Date:
1st Communion
1st Communion Date:
Confirmation
Confirmation Date:

Female Adult

Role: (Head of household, Husband, wife etc.. required)
First Name/Nickname: (required)
DOB: (required)
Special Needs:
First Language:
Second Language:
Ethnic Origin:
School:
Education Level:
Occupation:
Employer:
Work Phone:
Cell Phone:
Sacramental Info:
Catholic
RCIA
RCIA Date:
If Other Religion:
Baptism
Baptism Date:
1st Communion
1st Communion Date:
Confirmation
Confirmation Date:

Additional Family Members/Children Information

1st Family Member

Relationship to household: (son, daughter, mother etc..)
First Name:
Last Name:
Gender:
Birthdate:
Birthplace:
High School Grad Year:
School First Language:
Catholic
Baptism
Baptism Date:
1st Communion
1st Communion Date:
Confirmation
Confirmation Date:

2nd Family Member

Relationship to household: (son, daughter, mother etc..)
First Name:
Last Name:
Gender:
Birthdate:
Birthplace:
High School Grad Year:
School First Language:
Catholic
Baptism
Baptism Date:
1st Communion
1st Communion Date:
Confirmation
Confirmation Date:

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