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Our Lady of the Black Hills Church Registration Form

* Required Fields

Registration Type:
New Member - New Registration
Current Member - Updated Registration Information

Catholic Head of Household: *

Mailing Address: *
 City: *
 State: *
 Zip: *
Physical Address: (if different)
 City:
 State:
 Zip:
Winter Address: (if applicable)
 City:
 State:
 Zip:

Home Phone:
Unlisted Yes No
Winter Phone: (if applicable)
Unlisted Yes No

Email Address:
May we contact you by email? Yes No

Do you want envelopes for parish contributions? Yes No

Please comple an entry for each person in the home

1. Catholic Head of Household: *
 Religion: *
 Birth Date: *
 Workplace & phone / School name: *
Category: * Adult Infant - Pre-School Grade K-8 Grade 9-12 College Age 16-21 not in school
Marital Status:
*		 Single Widow/Widower Divorced
Both Catholic/valid marriage Both Catholic/not valid marriage
Interfaith/valid marriage Interfaith/not valid marriage Living together/outside of marriage
2. Full Name:
 Religion:
 Birth Date:
 Workplace & phone / School name:
Category: Adult Infant - Pre-School Grade K-8 Grade 9-12 College Age 16-21 not in school
Marital Status: Single Widow/Widower Divorced
Both Catholic/valid marriage Both Catholic/not valid marriage
Interfaith/valid marriage Interfaith/not valid marriage Living together/outside of marriage
3. Full Name:
 Religion:
 Birth Date:
 Workplace & phone / School name:
Category: Adult Infant - Pre-School Grade K-8 Grade 9-12 College Age 16-21 not in school
Marital Status: Single Widow/Widower Divorced
Both Catholic/valid marriage Both Catholic/not valid marriage
Interfaith/valid marriage Interfaith/not valid marriage Living together/outside of marriage
4. Full Name:
 Religion:
 Birth Date:
 Workplace & phone / School name:
Category: Adult Infant - Pre-School Grade K-8 Grade 9-12 College Age 16-21 not in school
Marital Status: Single Widow/Widower Divorced
Both Catholic/valid marriage Both Catholic/not valid marriage
Interfaith/valid marriage Interfaith/not valid marriage Living together/outside of marriage
5. Full Name:
 Religion:
 Birth Date:
 Workplace & phone / School name:
Category: Adult Infant - Pre-School Grade K-8 Grade 9-12 College Age 16-21 not in school
Marital Status: Single Widow/Widower Divorced
Both Catholic/valid marriage Both Catholic/not valid marriage
Interfaith/valid marriage Interfaith/not valid marriage Living together/outside of marriage

Note/Comment:

If you are concerned about sending this information across the internet, complete the form online, print the document using your browser's print function, then mail or deliver it to the office. Or you can pick up a printed form at the office.

Copyright © 2003-2010, Our Lady of the Black Hills
Updated: March 27, 2008
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