CCSFX Registration Form

Join the Catholic Community of St. Francis Xavier

Note: A red ( * ) means the field is required

* Family Last Name:
* Home Phone Number:
* Street Address:
* City or Town:
* Zip Code:
Mailing Address (if different from above):

Family e-mail address:
May we include your phone and address in our parish directory?: Yes No
Do you want to use electronic transfer of funds? (if yes, please call the Parish Office): Yes No
Marital Status:
Date of wedding (mm/dd/yyyy):
Wife's Maiden Name:
If married & want our mailings addressed other than "Mr. & Mrs." please indicate title here:

Head of Household Information:

Male:
Full Name:
Preffered Name:
Date of Birth (mm/dd/yyyy):
Please indicate religion:
Baptized? Yes No
RCIA? Yes No
Confirmed? Yes No
Occupation (please be specific):
Work phone:
Cell phone:
Email address:

Female:
Full Name:
Preffered Name:
Date of Birth (mm/dd/yyyy):
Please indicate religion:
Baptized? Yes No
RCIA? Yes No
Confirmed? Yes No
Occupation (please be specific):
Work phone:
Cell phone:
Email address:

Are there any special needs for you or your spouse?

Do you wish to receive the Catholic Review (Archdiocesan Newspaper): Yes No

Children Information:

First Child:
Child's Name:
Preferred Name:
Birth Date (mm/dd/yyyy):
Gender: Male Female
Please indicate Religion:
Baptized? Yes No
First Eucharist? Yes No
Confirmed? Yes No
Current grade in school:
Current School attending:
Special Needs?

Second Child:
Child's Name:
Preferred Name:
Birth Date (mm/dd/yyyy):
Gender: Male Female
Please indicate Religion:
Baptized? Yes No
First Eucharist? Yes No
Confirmed? Yes No
Current grade in school:
Current School attending:
Special Needs?

Third Child:

Fourth Child:

Fifth Child:

Time & Talent Stewardship - A Way of Life

Please check any of the following ministries or commitees that you would like to receive more information on

Liturgical Ministries Altar Guild Altar Servers Baptism Preparation Ministry Hospitality at Mass Environment & Art Eucharistic Ministers Greeters Lectors Music Nursery God's Little Lambs Sacristans	Faith Formation Adult Faith Formation Sponsor Couple Marriage Prep RCIA & RCIC Team Members Middle School Youth Ministry Family Catechesis Summer Camp Helpers Bereavement City of God Prayer Group Confirmation Bible Studies
Outreach Ministries Beans & Bread Casseroles Project Share Our Daily Bread Sandwich Making UCAN (United Churches Assistance Network) Bingo at Springfield State Hospital Giving Tree Adopt-a-Family Prison Ministry	Parish Committees Community Activities Facilities & Grounds Faith Formation Finances Gospel of Life Liturgy Mission & Planning Outreach & Advocacy Youth Ministry