Family Name Address City Zip Code Date Telephone Language Spoken at Home Years in this Parish Family Residence TenantOwner Head of Household MarriedSeparatedDivorcedWidowedSingle List only those living with you (Including last name if different): Husband: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Email Address Wife: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Email Address Child 1: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Child 2: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Child 3: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Child 4: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Child 5: Name Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Others Living with You: Name How Related Date of Birth Country of Birth Religion Baptism YesNo First Communion YesNo Confirmation YesNo Mass Attendance Church Society School/Occupation/Homebound Δ
