St. Francis of Assisi Parish Confidential Parish Census Information
Family Name
Street Address/Town/State/Zip
Mailing Address (If different)
Home Telephone
Is this number listed?
Family Email Address
Name & Place of Previous Parish
Would you like to receive contribution envelopes?
If you answered, "Yes," would you like weekly or monthly envelopes?
Would you like to schedule an appointment to meet with the pastor?
Marriage Information If the Heads of the Household are married, please provide the following information:
Married by a
Church of Marriage
City/Town & State of Marriage
Date of Marriage MM/DD/YYYY
Head of Household Name (First, Middle, Last)
Maiden Name (If Applicable)
Date of Birth (MM/DD/YYYY)
Religion
Baptized?
Received First Holy Communion?
Confirmed?
Marital Satus
Occupation
Years of Education
Special Needs?
If there are no other members, please scroll to bottom of form to submit. Otherwise, please continue.
Spouse Name (First, Middle, Last)
Maiden Name (If Applicable)
Date of Birth (MM/DD/YYYY)
Religion
Baptized?
Received First Holy Communion?
Confirmed?
Mass Attendance
Marital Status
Occupation
Years of Education
Special Needs?
If there are no other members, please scroll to bottom of form to submit. Otherwise, please continue.
Child/Dependent 1 Full Name (First/Middle/Last)
Gender
Date of Birth (MM/DD/YYYY)
Relationship to Head of Household
Baptized?
Received First Holy Communion?
Confirmed?
Attends Mass Regularly?
Occupation
School
Grade
Special Needs
If there are no other members, please scroll to bottom of form to submit. Otherwise, please continue.
Child/Dependent 2 Full Name (First, Middle, Last)
Gender
Date of Birth (MM/DD/YYYY)
Relationship to Head of Household
Baptized?
Received First Holy Communion?
Confirmed?
Attends Mass Regularly?
Occupation
School
Grade
Special Needs?
If there are no other members, please scroll to bottom of form to submit. Otherwise, please continue.
Child/Dependent 3 Full Name (First, Middle, Last)
Gender
Date of Birth (MM/DD/YYYY)
Relationship to Head of Household
Baptized?
Received First Holy Communion?
Confirmed?
Attends Mass Regularly?
Occupation
School
Special Needs
Grade
If there are no other members, please scroll to bottom of form to submit. Otherwise, please continue.
Child/Dependent 4 Full Name (First, Middle, Last)
Gender
Date of Birth (MM/DD/YYYY)
Relationship to Head of Household
Baptized?
Received First Holy Communion?
Confirmed?
Attends Mass Regularly
Occupation
School
Grade
Special Needs?
If there are additional members of your family, please submit this form and open a new form. Simply enter the family name and the word "Continued." Then scroll down to "Child/Dependent 1" and complete information about the additional members. Then submit.
