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Join Divine Mercy / Reactivate Your Membership
Today's Date
*
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Status
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I am new
I would like to reactivate my membership
Family (Last) Name
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Heads of household first names
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Primary Residence - Street Address
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City, ST, Zip
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Best Email Address
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Confirm email:
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Primary Phone
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Secondary Phone
Secondary Residence - Street Address
City, ST, Zip
Dates at secondary residence: from approx.
to approx.
Adult Male Name (First, Middle, Last)
Adult Male Birth Date
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Title
Mr.
Dr.
Other
Suffix
Jr.
Sr.
II
III
IV
Other
Marital Status
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Single
Married
Divorced
Separated
Widowed
Adult Male Nickname
Ethnicity
Primary language
Cell phone
Work phone
E-mail address
Adult Male religion
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Catholic
Other
Other
Sacraments received
*
Baptism
1st Communion
1st Reconciliation
Confirmation
Marriage
Holy Orders
None
Baptism details: Date, Church, City, Priest, Godparents (if known)
1st Communion details: Date, Church, City, Priest (if known)
1st Reconciliation details: Date, Church, City, Priest (if known)
Confirmation details: Date, Church, City, Priest or Bishop, Sponsor, Confirmation Name
Marriage details: Date, Church, City, Spouse, Priest
Adult Female Name (First, Middle, Last)
Adult Female Birth Date
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Title
Miss
Mrs.
Ms.
Dr.
Other
Suffix
Jr.
Sr.
II
III
IV
Other
Marital Status
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Single
Married
Divorced
Separated
Widowed
Maiden Name
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Nickname
Ethnicity
Primary language
Cell phone
Work phone
E-mail address
Adult Female religion
*
Catholic
Other
Other
Sacraments received
*
Baptism
1st Communion
1st Reconciliation
Confirmation
Marriage
Holy Orders
None
Baptism details: Date, Church, City, Priest, Godparents (if known)
1st Communion details: Date, Church, City, Priest (if known)
1st Reconciliation details: Date, Church, City, Priest (if known)
Confirmation details: Date, Church, City, Priest or Bishop, Sponsor, Confirmation name
Marriage details: Date, Church, City, Spouse, Priest
Address parish mailings to:
*
Both spouses listed
Catholic spouse listed only
Child Full Name (First, Middle, Last)
Child Birth Date
*
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Gender
*
Male
Female
Nick name
Ethnicity
Language
Religion
*
Sacraments received
*
None
Baptism
1st Communion
1st Reconciliation
Confirmation
Baptism details: Date, Church, City, Priest, Godparents (if known)
First Communion details: Date, Church, City, Priest (if known)
First Reconciliation details: Date, Church, City, Priest (if known)
Confirmation details: Date, Church, City, Priest or Bishop, Sponsor, Confirmation Name
Child Full Name (First, Middle, Last)
Child Birth Date
*
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Gender
*
Male
Female
Nick name
Ethnicity
Language
Religion
*
Sacraments received
*
None
Baptism
1st Communion
1st Reconciliation
Confirmation
Baptism details: Date, Church, City, Priest, Godparents (if known)
First Communion details: Date, Church, City, Priest (if known)
First Reconciliation details: Date, Church, City, Priest (if known)
Confirmation details: Date, Church, City, Priest or Bishop, Sponsor, Confirmation Name
Child Full Name (First, Middle, Last)
Child Birth Date
*
+
Gender
*
Male
Female
Nick name
Ethnicity
Language
Religion
*
Sacraments received
*
None
Baptism
1st Communion
1st Reconciliation
Confirmation
First Communion details: Date, Church, City, Priest (if known)
First Reconciliation details: Date, Church, City, Priest (if known)
Confirmation details: Date, Church, City, Priest or Bishop, Sponsor, Confirmation Name
Child Full Name (First, Middle, Last)
Child Birth Date
*
+
Gender
*
Male
Female
Nick name
Ethnicity
Language
Religion
*
Sacraments received
*
None
Baptism
1st Communion
1st Reconciliation
Confirmation
Baptism details: Date, Church, City, Priest, Godparents (if known)
First Communion details: Date, Church, City, Priest (if known)
First Reconciliation details: Date, Church, City, Priest, Godparents (if known)
Confirmation details: Date, Church, City, Priest or Bishop, Sponsor, Confirmation Name
What are your Interests?
Helping in the office
Working with Children
Mentoring Teens
Singing / playing an instrument
Landscaping / Mowing / Shoveling
Greeting / welcoming people
Visiting people in their homes
Bringing the Eucharist to those who cannot attend Mass
Other
Other
Special Notes of Interests or Questions You May Have
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