San Roque Catholic Church Family Registration

Thanks for taking a moment to register your household's information with our parish's office. Please fill out the form as completely as possible and then click submit.  If you have any questions please do not hesitate to contact the San Roque Parish Office by phone, (805) 687-5215, or by email, office@sanroqueparish.org.  

Contact Information
Last Name
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First Name(s)
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Mailing Name
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(ie Mr. & Mrs. John Doe)
Address
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Home Phone -- ext
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Phone 2 -- ext
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Family E-mail
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Person 1 Information
Household Role
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Name
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Gender
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Date of Birth //
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Phone 1 -- ext
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Phone 2 -- ext
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E-mail
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First Language
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Occupation/Employer
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Were you baptized in the Catholic Church?
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Date of Baptism  
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Baptism Church/Location
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Date of First Reconciliation  
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First Reconciliation Church/Location
  •  
Date of First Eucharist  
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First Eucharist Church/Location
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Date of Confirmation  
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Confirmation Church/Location
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Marital Status
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Valid Catholic Marriage
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Person 2 Information
Name
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Gender
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Date of Birth //
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Phone 1 -- ext
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Phone 2 -- ext
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E-mail
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First Language
  •  
Occupation/Employer
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Were you baptized in the Catholic Church?
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Date of Baptism  
  •  
Baptism Church/Location
  •  
Date of First Reconciliation  
  •  
First Reconciliation Church/Location
  •  
Date of First Eucharist  
  •  
First Eucharist Church/Location
  •  
Date of Confirmation  
  •  
Confirmation Church/Location
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Marital Status
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Valid Catholic Marriage
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Household Role
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Dependent Person 1 Information
Relationship to Head of Household
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Name
  •  
Gender
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Birthdate //
  •  
Birthplace
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First Language
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School
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High School Graduation Year
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Religion
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Has this individual been baptized in the Catholic Church?
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Date of Baptism  
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Baptism Church/Location
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Date of First Reconciliation  
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First Reconciliation Church/Location
  •  
Date of First Eucharist  
  •  
First Eucharist Church/Location
  •  
Date of Confirmation  
  •  
Confirmation Church/Location
  •  
Dependent Person 2 Information
Relationship to Head of Household
  •  
Name
  •  
Gender
  •  
Birthdate //
  •  
Birthplace
  •  
First Language
  •  
School
  •  
High School Graduation Year
  •  
Religion
  •  
Has this individual been baptized in the Catholic Church?
  •  
Date of Baptism  
  •  
Baptism Church/Location
  •  
Date of First Reconciliation  
  •  
First Reconciliation Church/Location
  •  
Date of First Eucharist  
  •  
First Eucharist Church/Location
  •  
Date of Confirmation  
  •  
Confirmation Church/Location
  •  
Dependent Person 3 Information
Relationship to Head of Household
  •  
Name
  •  
Gender
  •  
Birthdate //
  •  
Birthplace
  •  
First Language
  •  
School
  •  
High School Graduation Year
  •  
Religion
  •  
Has this individual been baptized in the Catholic Church?
  •  
Date of Baptism  
  •  
Baptism Church/Location
  •  
Date of First Reconciliation  
  •  
First Reconciliation Church/Location
  •  
Date of First Eucharist  
  •  
First Eucharist Church/Location
  •  
Date of Confirmation  
  •  
Confirmation Church/Location
  •  
Dependent Person(s) Information
Are there any members of your household who would like to be visited by a priest?
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  •  
 
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