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St. Hubert Catholic Church Registration/Update Form

Family/Head of Household Last Name (required)
Today's Date:
Home Phone:
Cell Phone:
Cell Phone:
Email Address: [primary-email]

Mailing Address
City
State
Zip

Physical Address (if different from above)
City
State
Zip

Do you live here: Full-TimeWeekenderSummer Only
If not a full time resident, please provide your alternate residence:
Alternate Address
City
State
Zip

Head of Household:MarriedSingleSeparatedDivorcedWidowed
Wedding Date, if married:
First Name:
Middle Name:
Preferred Name:
Date of Birth:
Religion:
Baptism: YesNo
1st Communion: YesNo
Confirmation: YesNo
Primary Email Address (Required):
Secondary Email Address:
Retired / Still Employed: RetiredStill Employed
Hobbies/Professional Interests:

Spouse:
Last Name, if different from Head of Household:
First Name:
Middle Name:
Preferred Name:
Date of Birth:
Religion:
Baptized? YesNo
1st Communion? YesNo
Confirmation? YesNo
Primary Email:
Secondary Email:
Retired/Still Employed: RetiredStill Employed
Hobbies/Professional Interests:

OTHERS LIVING IN THE HOME: Please give last names if different than family name:
Name	Female/Male	DOB	Relationship	Baptism	1st-Comm.	Confirmation	School/Occupation/Homebound
	FM			YN	YN	YN
	FM			YN	YN	YN
	FM			YN	YN	YN
	FM			YN	YN	YN
	FM			YN	YN	YN
OTHER ADULTS LIVING IN THE SAME HOME SHOULD REGISTER INDEPENDENTLY.

Disclosure Authorization
Please check the selections below indicating the information that you give permission to be published in the St. Hubert Church Directory & sign below. Also indicate any specific instructions for information to be included or excluded from the directory.
Names of AdultsNames of ChildrenPhone NumbersEmail AddressesHome/Mail Addresses
Other Instructions:
Name of Person Providing Authorization:

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