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St. James Catholic Church |
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St. James Catholic Church |
St. James Census Form - 2012
Today’s date: __________________________
Registered parishioners, print out this copy and fill out
(one per household by couple, or by single adult, age 21 and over.)PLEASE P-R-I-N-T
I. PERSONAL BACKGROUND
Name (male adult):_______________________________________________________ Birth date:____-____-____
(First) (Middle name) (Last)
(female adult):_____________________________________________________________________________
(First) (Middle name) (Last) (Maiden name)
Female’s birth date:___-___-____
Marital status: Married ___ Single ___ Separated ___ Divorced ___ Widowed* ___
*Spouse’s date of death: _____________
Home address: ___________________________________________________ ZIP code: ___________________
Main phone:______________________________ listed/unlisted? Main e-mail: ________________________
Secondary e-mail:__________________________
Phone (male): Cell:________________________________ _Work:________________________
Phone (female): Cell:________________________________ _Work:________________________
Employer: __________________________________ Occupation or Position: _____________________________
(for male)
Employer: __________________________________ Occupation or Position: _____________________________
(for female)
Retired: (male): Yes / No Former occupation: ______________________________________________
Retired (female): Yes / No Former occupation: ______________________________________________
Preferred name for mailings from parish: ____________________________________________________
(Example: Matt or Matthew, Jenny or Jennifer?)
II. SACRAMENT BACKGROUND:
(MALE) (Denomination) (FEMALE) (Denomination)
Baptized as an Infant ______ _____________ _______ _____________
or as an Adult: ______ _____________ _______ ______________
*Profession of Faith: ______ ___________(*date)` _______ _____________(*date)
*Date you joined the Catholic Church through the RCIA program)
First Communion: Yes / No ______ Yes / No ______
First Reconciliation: Yes / No ______ Yes / No ______
Confirmation: Yes / No ______ Yes / No ______
Married by Catholic Priest? Yes / No _______ (If “No,” circle denomination below.)
Baptist Methodist Episcopalian Presbyterian Lutheran Justice of Peace Other
Marriage date: ___ - ___ - _____ Marriage validation date*: ___ - ___ - ___(*Marriage blessed in Church)
If spouse is non-Catholic, spouse’s denomination: ____________________________
III. FAMILY BACKGROUND
(List children living at home and under the age of 21.) Children over 21 years of age will need to register as an adult.
Children: Name (First, Middle, Last) Birthdate Baptized 1st Comm. Conf. School and grade
mo/day/yr (denomination) Y / N Y / N
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
______________________________________ ___-___-____ ___________ _______ ______ ________________ __
Adult children 21 and over (List adult children who are attending St. James Church.)
NAME ADDRESS PHONE
_______________________________________________________________________________ ________________________
_______________________________________________________________________________ ________________________
_______________________________________________________________________________ _______________________
_______________________________________________________________________________ ________________________
_______________________________________________________________________________ ________________________
Immediate family living in parish: (parents, siblings)
1. ____________________________________________ 4.____________________________________________________
2. ____________________________________________ 5. ____________________________________________________
3. ____________________________________________ 6. ____________________________________________________
IV. SPECIAL INTEREST(S) BACKGROUND (optional)
Activities / groups / organizations
(Male)_________________________________________ (Female) _______________________________________
(Male)_________________________________________ (Female) _______________________________________
(Male)_________________________________________ (Female) _______________________________________
Additional comments or information, including special skills, talents,
hobbies, etc.
_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
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