Catholic Diocese of Richmond
Parish Registration Information

The information you provide on this census form will be used exclusively within the Church.

Are you presently registered in this parish?  yes  no
If yes, please state the year of original registration. 
Were you previously registered in another parish in the Diocese of Richmond?  yes  no
If yes, please name the parish:. 
Location:

Household Mailing Information
(Please complete as you want mail addressed to your household, including title(s).)

Name:
P. O. Box, if any:
Street Address:
City/State/Zip:
Email:
Home Phone:
Are there any special circumstances or information of which the parish should be aware?
Please provide directions to your home, include subdivision names, rural routes or street names which may be helpful in locating you.

Household Member Information
Please only enter people who are presently residing in your household or who are temporarily away for college or military.

Head 1

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)
Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Head 2

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)
Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Other Adult 1  Child 1

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Present Grade:
(Children Only)
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)
Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Other Adult 2  Child 2

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Present Grade:
(Children Only)
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)
Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Other Adult 3 Child 3

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Present Grade:
(Children Only)
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)
Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Other Adult 4  Child 4

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Present Grade:
(Children Only)
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)
Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Other Adult 5  Child 5

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Present Grade:
(Children Only)
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)

Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance

Other Adult 6  Child 6

First Name:
Last Name:
Personal Status:
Religion:
Disability:
1st Language:
(if not English)
If other language option selected, please specify: 
2nd Language:
If other language option selected, please specify: 
Occupation:
Company/School:
Business Phone:
Present Grade:
(Children Only)
Sex:  Male  Female
Ethnicity/Race:
Birthdate:
(mm/dd/yy)

Sacraments Received:  (check all received)

Baptism
1st Communion
Confirmation
Marriage
1st Penance