Welcome to St. Patrick Catholic Church!

INSTRUCTIONS:

A complete parish registration includes 2 separate forms:

  • FORM 1: Household Information including adults and chlidren
  • FORM 2: Time & Talent Opportunities

After you submit the first form you will be taken to the second.

Thanks for registering with St. Patrick!
Registration Form 

Household Information
Family Information
Family Name:
 *
Home Phone:
Street Address:
State:
Home E-mail Address:
Is your phone listed?
Yes
No
City:
Zip Code:
Adult Member Information
Adult 1
First Name1:
Middle Name1:
Last Name 1:
Nickname1:
Male or Female?
Male
Female
Birthday1 (MM-DD-YYYY):
Occupation1:
Employer1:
Work Phone1:
Work E-Mail1:
Cell Phone1:
Marital Status1:
If married date married1:
Adult 2
First Name2:
Middle Name2:
Last Name2:
Nickname2:
Male or Female?
Male
Female
Birthday2:
Occupation2:
Employer2:
Work Phone2:
Work E-Mail2:
Cell Phone2:
Marital Status2:
If married date married2:
Adult 3
First Name3:
Middle Name3:
Last Name3:
Nickname3:
Male or Female?
Male
Female
Birthday3:
Occupation3:
Employer3:
Work Phone3:
Work E-Mail3:
Cell Phone3:
Marital Status3:
If married date married3:
Information on Children and other Household Members
Member 1
First NameC1:
Middle NameC1:
Last NameC1:
NicknameC1:
Male or Female?
Male
Female
BirthdateC1 (MM/DD/YYYY):
School/CollegeC1:
GradeC1:
Please check the Sacraments celebrated:
Baptism
First Eucharist
Confirmation
Member 2
First NameC2:
Middle NameC2:
Last NameC2:
NicknameC2:
Male or Female?
Male
Female
BirthdateC2:
School/CollegeC2:
GradeC2:
Please check the Sacraments celebrated:
Baptism
First Eucharist
Confirmation
Member 3:
First NameC3:
Middle NameC3:
Last NameC3:
NicknameC3:
Male or Female?
Male
Female
BirthdayC3:
School/CollegeC3:
GradeC3:
Please check the Sacraments celebrated:
Baptism
First Eucharist
Confirmation
Member 4
First NameC4:
Middle NameC4:
Last NameC4:
NicknameC4:
Male or Female?
Male
Female
BirthdayC4:
School/CollegeC4:
GradeC4:
Please check the Sacraments celebrated:
Baptism
First Eucharist
Confirmation
Member 5
First NameC5:
Middle NameC5:
Last NameC5:
NicknameC5:
Male or Female?
Male
Female
BirthdayC5:
School/CollegeC5:
GradeC5:
Please check the Sacraments celebrated:
Baptism
First Eucharist
Confirmation
Member 6
First NameC6:
Middle NameC6:
Last NameC6:
NicknameC6:
Male or Female?
Male
Female
BirthdateC6:
School/CollegeC6:
GradeC6:
Please check the Sacraments celebrated:
Baptism
First Eucharist
Confirmation
If any member has Special Needs please list the first name followed by the natuer of the special need:
If any members of your Household (adults or children) are not Catholic please list their name and religious affiliation:
Security code:
 *
Do not enter anything in this field:

* indicates a required field

    St. Patrick's Catholic Church
    120 5th St NW
       Cedar Rapids, IA 52405
            Parish Office:319 362-7966